Follow the money.

There is too much evidence of the financial interests in the pharmaceutical industry.

I am concerned about real or imagined experts acting as sock puppets for pharmaceutical marketing efforts.

This is not good for people who actually need help in their lives.

It's another case of missing the real roots of madness. IMO, "mental illness" and "behavior disorders," in adults and children alike, are an environmental problem. The autism saga has proven that something once called "childhood schizophrenia" is now coming to be seen as mercury toxicity, or a broader compilation of insults from various toxic metals, synthetic chemicals, stealth infections, etc. I ask: why can't the mental health field in general learn from the productive research-and-treatment foment going on now--mainly spurred by parents--in the autism community? (Many of us consider ADD/ADHD part of the spectrum of autism disorders.)

If we posit the physiological aspect (often there's a gut-brain connection) of what ails our "minds," then yeah, it makes sense to cast a wider net--hard to find someone these days who's not fighting brain fog or impaired attention to an ever faster paced world. But has the DSM in any incarnation ever done us a favor? You are completely correct that this move will serve the wrong pockets. True, adults supposedly have choice. But what choice do we have when true information about alternative mental health (nutrients, diet, detox) is hard to find?

Best, Sue Westwind
www.thenutrientpath.wordpress.com

It is a real illness, and the stimulants are the first line of treatment for a good many of legitimate presentations. But, treatment has to include therapy, even if just supportive and structured. A great workbook is Living with ADD, by Harbinger Publications.

Can't wait to read who attacks this comment.

I won't attack you therapyfirst...but it seems you're suggesting in this instance it should be medicine first??

I'm with Sue, myself---alternatives work for people with ADD diagnosis too...

and though I don't think I've once mentioned it, I was slapped with an ADD diagnosis at one time...the cause of the lack of attention???

too many drugs on board...that's about it...

I was fine before I took meds.

What I don't hear from enough of posters in these commentary sections as a new participant at this site is psychiatry is a gray field: you can have ten patients come into the office and present with signs and symptoms of an illness, for the sake of this posting call it ADD, and I could offer ten different treatment options and hopefully have all ten come back in three months or longer with reports of progress and satisfaction. Note the time frame in my hypothesis, as that is reality in my field

So many of you are quick to refute my recommendations. Well, here is the fact that I learned in my training and have seen and continue to see with legitimate presentations of ADD: More than half of patients with predominate signs and symptoms that started in childhood and continued on into adulthood seem to benefit with medication, stimulants being the most effective as a group overall. Meds did not remove or control all the problems, but they impacted enough to get patients to further problem solve with therapy, education, and effort to make even further progress. I have met a good number of patients in the past 15 years who have thanked me for offering the treatments I provided and they have said in so many words, "you have helped me improve my life."

I have never put a figurative gun to any of my patients' heads and said "do what I say or you will be harmed", and yet I get the sense there are some here who would say that's what happened to them. If treatment was coerced, forced, threatened, or demanded on you, in my opinion that was not treatment. I can't find the word to call what this would be, but I would not call it care or healing. I think my deeds match my words, so I know you as readers don't see what I do, but I hope the consistency in what I write has some validation to what I do.

A bit of a rant, but I feel it needs said.

Only the negative and outrageous get coverage in the media; maybe that is because good things are taken for granted and are boring to spectators.
Well, I see good, and I hope you do too.

TF, This is not mean't as an attack. I would just like to know from a Psychiatist's prespective - You state something to the effect that you have 15 years of seeing patients benefit from medications (hope I got that right) - In that time
how many of those patients that have "thanked you" somehow dispeared from your care? The reason I ask is this - When I was in treatment I thought I had the most wonderful doctors. Quiet honestly I thought they were the best and even told them so. One time I was hospitalized and received the same doctor I had on the previous visit(this hospitalization occurred within three months of the last one). I told the doctor that I was "happy" they had reassigned him to me and I really truely was. This doctor was the one that prescribed ECT. I thought he was wonderful. I thought my regular pdoc was wonderful and I thought my ECT pdoc was wonderful. They were all truley working for me to be depression free.

Then I began to realize I had more memory loss than "just around the time of treatments" and refused to have anymore. Right around that time I also stopped all the medications because frankly I wanted to die. At that time I thought the medications were keeping me alive and I just didn't want to live anymore so I stopped all 9 of them. I didn't know at that time that stopping these medications all at once caused some pretty nasty behaviors. I thought it was my illness getting worse from not taking medications, but I didn't care I wanted to die.

I was re-hospitalized, and was threatened with a long term residental treatment facility if I continued to refuse their treatments.

When ECT did not work after more than a year of weekly treatments, my hope that things could ever get better was completely gone. I didn't care if I died so I continued to refuse any and all treatments until it became quite clear I was not going to get out of the hospital.

I began the medications again only to get released from the hospital. once released I stopped all the medications again. Over time I began feeling better and better and now realize it was the medications that had been keeping me from getting well.

I'm sure all three of those doctors believe to this day, they provided me with the best care and saw remarkable improvements from the medications and ECT they used. I'm certain that if they saw me today they would each take credit for my depression free life. Every part of their being would tell them they saved my life.

All three of those doctors beleiieved I needed more ECT and more medications. They were convienced I could not live without them. Guess what? I hate all three of them! They kept me sick on the medications and damaged my brain with ECT. They took my life away from me by taking my memory. I don't remember my family and friends, my dog, my college degrees. I will never get my past life memories back. My connections to all those things are gone.

Everyone of my doctors would count me as a patient they treated and "thanked" for their treatments. Their treatments that nearly killed me. I hope someday to tell those pieces of shit what I think about them now. I have no doubt those doctors would take credit for my depression free life right now. I would get no credit whatsoever for getting myself off my "treatment resistant" medications and building a life with a 25 point IQ reduction from the ECT. No, those doctors are probably blogging about how wonderfully effective their treatments are because I thanked them and was so grateful they treated me.

TF,

You can't think of word? I call it rape - legalized, institutionalized rape.

I find it hard to believe you lead a sheltered life. Have you no experience with inpatient commitment? You'll find plenty of force and coercion there. Outpatient is already forced "treatment" option in many U.S. states.

Are you telling us you've never had a patient who "lacked insight" into their "disease"? You must have delved in this in your professional training. It's at the core of how psychiatry hoodwinks the courts to deprive one of their liberty and to force medication and procedures upon them.

Tell us there's no coercion when educators and counselors threaten loss of custody upon families than won't medicate their "unruly" kids - mostly boys it seems. The kids, of course, have no say as to whether their brains are fried over or sunny side up. Your patients may well have had a figurative gun pointed to their head long before they walked through your door. It's hard to know patients won't tell you.

I rather enjoy your comments. They make me think of an unreal, but very pleasant, suburban psychiatry. This is not what your mainstream colleagues are busy practicing and driving, however.

(you can bet therapy won't be pushed)
I wonder how are the 15 years patient's journal.
It's interesting that people not only change drugs but also change physicians.
At least that's what happens here.
It seems to me that in US because of Medicaid and Medicare it's harder for middle class to change psychiatrists. Am I wrong?
Middle class around here has to go to private psychiatrists and private clinics.

Jane,
Thank you for sharing your story. I've been on 8 psychiatrists and the one who put me on 6 drugs on high doses was also wonderful.
It's a long story. I'll try to write about it later.

TF,
You have 15 years of "practice" being the other side of the table asking questions.
Some people here have 30, 40 years experiencing not only meds but the problem.
They have a lot of practice as you can see.
Some patients were capable of studying psychiatry and now are PhD.
Patricia Deegan is one of them.
Here http://www.power2u.org/articles.html you can find her:
"Reclaiming your power during medication appointments with your psychiatrist" (I've translated it into Portuguese)
and
* Principles of a Recovery Model Including Medications (pdf)
I believe you all know it but... just in case.

TherapyFirst, I won't attack you either. You say that ADD/ADHD is an illness. You are wrong. It is not an illness. It is a clinical impression, severely skewed by the bias inherent in the psychiatric industry. ADD/ADHD was invented by the makers of the alleged "cure." If you believe it's an illness, then please posit here (for the benefit of all us dumb psychiatric assault survivors) the etiology of this disease. This wave of neurological disease which has swept over North America. What caused it? Somebody commented above that they enjoy your posts. I do not. I think you're a pompous git and should find another website. I'm sorry. I just attacked you. Please don't take it personally. I am attacking your profession and your point of view and your utter lack of critical thinking skills. You are not a bad person. I am not attacking your character. You actually think you help people. That terrifies me.

I am not going to debate those of you who are so over the top in your negativity regarding psychiatric diagnosis, treatment, and opinion.

I'd like to hear from said deniers of psychiatric services what you would offer the people who walk into primary care offices, or psychiatric offices, or OBGYN offices, hell, let's say they come to you after reading your gospel how what I do is so terrible, and said people complain of depression that causes suicidal thoughts and profound loss of motivation and lack of sleep and appetite that leads to fatigue and weight loss, or perhaps 5 to 7 day periods of excessive energy and racing thoughts that makes them spend $5,000 on their credit card and get fired from the job arguing with the boss that they do better work and can't shut up for 30 seconds to let someone else say something, or perhaps they never finished high school as they couldn't focus and remember the school work and were so hyper at home their parents constantly screamed at them and ended up using drugs to self medicate to decrease said symptoms.

You think these above scenarios are made up by me to trick people into coming to a provider and getting put on pills and coming every other week for 6 months or more for therapy? I'm sure all these holistic alternatives or dismissals offered by some at this site will put these impaired people at ease fairly quickly and return them to healthy levels of function.

You know what pisses me off the most? It's asshole colleagues in my field who diagnose and prescribe after 15 minutes with a patient, and extremists like some of you who deny there are any illnesses in need of care. I'm a moderate, and I believe some people really have problems, and some just need to hear the truth and reconsider their needs and options.

You don't believe there is an illness called Attention Deficit Disorder? Fine. I'm looking forward based on the dialogue here to what I should tell the next patient who comes in my office and describes decades of dysfunction, being demeaned by many around them, and struggling with flagrant needs and wants because what they are going through is not a problem, they're just confused or misinterpreting their situation.

It sucks to read that some of you went through shitting treatment experiences and felt like you had no say in your care. I truly feel for each and every revelation I have read here these past few weeks. But if you want to deny that there are real issues and problems out there for others, you aren't helping these people if they come to this site and read these commentaries. Your sharing is brave, candid, and probably painful to write. And it has a place for those who want to be educated and aware. I'm not wrong, though, I'm just not the person who was there when you were failed. I'm sorry for those of you who were mistreated; it doesn't mean it has to continue by refuting any and all interventions.

I've said this to people face to face; some hear it, some don't. I just know when I am wrong, but patients strive for change on other terms, I am often happy because such individuals come back to tell me they are better.

Isn't that what it is all about in the end?

Yes, it is what it is all about in the end, because if we waste our lives finding the middle, we have virtually lost our beginning and the end, and sometimes---too late.

Whatever works for real life happiness outside of this blog dialogue is what matters the most.

All I know is that when I took Ritalin, Adderall, & other uppers they gave me to treat depression my pig sty of an apartment became sparkling clean, all the canned goods in my pantry suddenly became aligned, and I even at one point began to turn cartwheels. Granted I didn't sleep, so there was more time for organizing household goods...and then that troubling little problem where the lack of sleep led to me peeking through the miniblinds w/ a wary eye. Other than that, I rather liked the uppers. There's a reason these scripts have to be written on triplicate forms. That's some good shit.

If you want happy customers, specialize in ADD/ADHD.

Nobody here denies that people have difficulties, TherapyFirst. I believe you are deliberately misinterpreting the comments posted. What the issue becomes is why does Big Pharma lead the way? I have had periods of intense depression. I very nearly died from liver failure due to poisoning myself. I have a lot of sympathy for people who are depressed. I just don't believe they are diseased or defective.

Case in point. I have a family member who has suffered depression almost all of her adult life. She was sliding into another bad one but was advised that now was not a good time. Her daughter is terminally ill and needs her support. So what did this diseased person do? She snapped out of it, refocused and became a suppport rather than a burden. You can't do that with real, physical diseases! You can't just smarten up and get on with your life. I've fallen into a depression because someone was mean to me on the telephone. And I've recovered from a depression by listening to music and interacting with animals.

And as far as the other end of the spectrum goes, I don't know anybody who spontaneously goes manic. There are triggers, manageable environmental factors that need to be addressed. Many, many bipolars are actually misdiagnosed chemically sensitive depressed people. The drugs fuck them up. For myself, I have had only one manic episode which was not immediately preceded by either electroshock treatment or antidepressants. In that one case, it was preceded by a non-psychiatric closed head injury.

Nobody listens to this information, TherapyFirst! I've been hospitalized 50 times or more. 50 times. Nobody but myself and a few very astute loved ones can see the pattern. And our opinion has no value. Psychiatry is an abomination. It's time for psychiatry to be reassessed in view of human rights law. These are legal and ethical issues, not medical ones.

As usual I went off on a tangent w/o answering the question. (If I were still taking Ritalin, I would have been more focused.) No, I do not believe they should loosen the criteria for diagnosing ADD/ADHD. Instead, why don't they rethink prescribing Ritalin, etc. when someone is already taking an antidepressant(s) and/or mood stabilizers because it can make a person bonkers.

From my European point of view I must say that this is a very good news. ADD in adults is such an under-diagnosed disorder and depression over-diagnosed. The trend of diminishing ADD in adults becomes very expensive to the system in different forms of addictions and secondary or even tertiary problematics.

Jane said:
"I'm sure all three of those doctors believe to this day, they provided me with the best care and saw remarkable improvements from the medications and ECT they used. I'm certain that if they saw me today they would each take credit for my depression free life. Every part of their being would tell them they saved my life."

therapyfirst, like Jane I have my own cadre of docs I've thanked and extolled. And, like Jane, I'm sure they'd be happy to take credit for my improved life, which only began when:
1) I stopped all psych meds
2) I ceased contact with the mental health profession
3) I later got diagnosed with--and treated appropriately for--hypothyroidism by my family doc's PA.

Number 3 didn't fix EVERYthing (you are correct--life *is* full of grey), but the laundry list of symptoms I've been pooh-poohed for bringing up for the past 30 years has abated with ten dollars a month's worth of thyroid meds.

At this point in my life I tell doctors anything I think they need to hear. I pander shamelessly to their bloated egos because I need things from them. Like refills on my thyroid meds. If you talk to laypeople on line or in real life you will hear the number one complaint they have about docs is "they don't listen". I have many interests and am constantly surprised by the virulence with which people on lists as varied as soapmaking, farming, writing, web design, etc. express their dislike of doctors. I know it's upsetting to you, but I have to tell you that what you're hearing here is merely the tip of a rather large iceberg and you would do well to ponder that knowledge instead of pushing it away like most of your colleagues. It's actually a privilege to hear the truth sometimes, however clumsily it may be expressed.

By the way, I did NOT come out of the box this way. I had the same favourable impression as most newcomers when I first made contact with your planet. I certainly didn't start out with what I'm sure you'd think of as a "bad attitude" (not that I'd ever be dumb enough to show it to you in a professional context).

When you are powerless you learn to be a suck up. It's a valuable survival skill. And the psychiatric patient IS powerless, thanks to the spectre of IEH that looms over each and every transaction you have with your patients--even if the patient isn't aware if this, you certainly are.

I know you like to think of yourself as one of the Good Guys, the ones with the white hats. But when I read you asking Phil to moderate comments you don't like, when I see you *so* patently unable to simply ignore trollish flames and so obviously needing to get in the last word, well, then my radar goes up. At that point any problem I may have with you has nothing whatsoever to do with my past experience, it has to do with your own current controlling behaviour. For example, you seem concerned that your colleagues might be driven away from someone else's blog. I find that curious.

My belief about doctors is that their boot-camp training engenders a sense of entitlement they carry into their career. It's the reason the very wealthy send their children to schools with cold showers and bad food--when they get out they have a sense they've suffered and are therefore entitled to their wealth. So it is with doctors, even the best of them (and I have no reason to doubt you're one of the better) believe they are entitled to their power. It's an unconscious belief they carry into their every transaction.

I really, totally LIKE my family doc. I owe him my life because he's stood by me in tough times. He's a genuinely nice, caring person. But he also didn't listen when I knew I was going through menopause, he misdiagnosed my hypothyroidism for over 20 years and generally tuned me out at several crucial times, for which I've paid dearly. I really don't trust his judgment, frankly, because, although he listens better than any doctor I've ever known, he still often doesn't listen. He does know me, has his heart in the right place and I'm unlikely to do better (could do worse) with a new doc.

So I tell him what he wants to hear--including how grateful I am for his help. He helped keep me marching in place for 20+ years, but some of his colleagues would have pushed me off a cliff so I guess, according to that low standard, you might say I mean what I say.

Many years ago I worked on the other side of the desk. I can look back now and identify a number of my clients who expressed gratitude for my help who were BSing me because they needed something from me. I can identify some who weren't, of course. Even a stopped clock is right twice a day.

So it is with you, whether you want to see it or not. Not with all of your grateful patients. But I guarantee you that some of them are putting you on, some are actually benefiting from your services and some will wake up later madder than hell because you've harmed them in your well meaning, but ignorant, efforts to help. And there's no way your efforts can be anything but mostly ignorant because the state of the art simply isn't "there" when it comes to mental illness.

Perhaps it's the old "one third get worse, one third get better, one third stay the same" paradigm. One third is quite a lot. Keep that in mind and maybe you'll be more humble. Humility is a psychiatrist's best friend.

Best wishes (because I want to believe you're trying to communicate and not merely control),
Sherry

Sherry:

why bother maintaining any relationship by lying?

If you were my patient and felt I did not provide you with the level of care you believed you needed, then you should tell me, and if I do not respond to this revelation with efforts to change and reevaluate the situation as your position had merit, then you say goodbye and find a new provider.

I appreciate the honesty in your writings above, but I am baffled to what your goals are in the end. I believe in truth and directness, so if there are patients who are lying to me, then they are the ones who are harmed in the end, not me, because I am going on what I know.

By the way, when people like you write things like "And there's no way your efforts can be anything but mostly ignorant...", that suggests your ignorance because you have never met me, been a patient under my care, worked with me as a fellow provider. So, these overgeneralized bashings are equally not respected when I am told my comments are not respected because I am a psychiatrist.

Hey, I'm interested in dialogue that provides education and enlightenment. Maybe I underestimated what I was getting into when I look again at the title of this blog. I'm furious over things, but I want to provoke healthy change because there are legitimate issues going on this author raises. People get pissed when I challenge things, but is it me, or does the status quo seems to suck more when nothing is offered to provoke healthy changes. Bitching without offering solutions that have validity is a waste of time in the end.

By the way, if I had control, why is it this submission has to go to the author for review before printed? I have said in prior postings I sensed I might get censored when I felt I was being harsh. I would offer maybe some people are wary or uneasy to attack the author for letting me be included here, or maybe some have already? Now there's some guts and honesty if that is true. Is this about real freedom of speech, or just maintaining a mob mentality?

think about that, if this is printed.

Sorry Philip, I had to respond to what she said.

TF,
Since you obviously weren't listening the first time, I'll repeat myself.

Why lie to doctors?
"because I need things from them. Like refills on my thyroid meds." In addition, with the insurance company privy to my conversations, I'd be an idiot to be free with information nowadays. You know how it is with pre-existing conditions. It's simply not safe, in a very practical way, to be honest anymore with any doctor or to bring up any information beyond what's absolutely necessary.

It's impossible to have an open and honest relationship, based on truth, when there is an imbalance of power. In that kind of situation the person in the one-up position often deludes themselves they're enjoying an open, honest relationship. The person in the one-down position knows better. This is true between individuals, within societies and between cultures, pretty much human nature. I just like to be clear and honest about it, at least with myself.

Why not express myself? Um, I have. I was ignored. I said that. Did you miss that part?

Why not change doctors?
"He does know me, has his heart in the right place and I'm unlikely to do better (could do worse) with a new doc." He really is a nice guy and he does know me. I see no point in starting over with a stranger when this guy can write a prescription as well as anyone. He also has an office in my town, nothing to sneeze at in this area.

By the way, I don't have to know you to know the state of the art in mental health medicine simply isn't "there" yet. If it was, we'd all be hearing about it and really very happy about it. We're here because it's not, remember? That statement was a commentary on the state of the art, not about you as a person. Sorry you took it personally.

As for your statement:
"By the way, if I had control, why is it this submission has to go to the author for review before printed?"
I never said you had control, I said you seem to desire it. This comes up for me when you ask Philip to moderate people more than he already is because you don't like what they're saying or how they're saying it; when you worry aloud that your colleagues might be driven away from a blog that is not yours; and when you're unable to take the high road and ignore flames but have to get in the last word. I don't know how else to interpret behaviour like that as anything but attempts to control what's going on.

Just to set your mind at ease when you say "I would offer maybe some people are wary or uneasy to attack the author for letting me be included here, or maybe some have already?" I trust you don't think there's any sort of group consensus to drive you out. That would be pretty weird and not at all congruent with my experience of this site. People come and go on blogs all the time, including this one.

You seem out of touch with the way you're coming across and not interested in learning from the feedback you're getting. I'm not sure what you expected when you came on to a site that's heavily populated by survivors of your abusive peers, announce you're a psychiatrist and appear to think your word holds more weight than other people's. That's been my experience of you. I'm sure that's not everyone's.

HTH.
Sherry