Daniel Carlat - Unhinged: The Trouble with Psychiatry

This talk was taped on June 2, 2010.

[allenkracalik]

Carlot handles this issue with kid gloves, not surprising, given his position. There is NO verifiable evidence whatsoever that these so-called "psychotropic" drugs are effective, and there is an OVERWHELMING body of evidence that they are harmful and dangerous, not only to those who take them, but to those around them as well. Their production and marketing should be legally terminated.

[martaaltheide]

In long term care, our elderly may be on 19 different meds. On asking their physicians for a re-evaluation, to discontinue some, the pushback was usually “ What medical school did you attend?” Follow the $.

[Blonde]

Almost everyone I have known cannot cope with angst… if you are sad or upset or even angry, the first thing people say is “ go see a therapist, have them put you on a pill” … no one wants to listen. Even therapists run out of ideas and suggest meds. It’s very disheartening.

[theresekirkpatrick]

I agree with psychiatrist should also do therapy. I rode the pharmaceutical roller coaster for decades. Did independent therapy and nothing helped. If anything the drugs made me worse. January 2018 I found a good psychiatrist to ween me off everything I was on a ton of stuff. It’s been a long difficult journey taking my mind and body back from the damage done. Most of these drugs are not studied long term or how difficult it is to get off them when they’re not working.

[goodgrief]

I was misdiagnosed with bipolar disorder 2 (depression with low “manic” periods, ) and placed on Paxil for depression, which I was on for 20 years before it was discovered that my “cycling moods” coincided with my menstrual periods - something no psychiatrist ever bothered to ask me about or make any kind of connection to. I also had PTSD related to traumatic events around my childhood that my prescribing psychiatrist(s) never bothered to get to finding out about, due to asking me a few questions about symptoms and then throwing an Rx my way based on those symptoms. I feel cheated out of many years of being treated for the wrong condition with incorrect medications because SSRIs were being pushed so heavily, so it was easy to diagnose every single patient that came in for help with various conditions with whatever could be “treated” with an SSRI. I had one psychiatrist that kept trying to change up my meds to Lithium, Neurontin, Depakote, Lamictal, etc, creating a very unstable mood situation for me while she experimented on me trying to get the meds right, since I had been diagnosed with bipolar. She would switch my meds every few weeks when these inevitably made me feel worse or didn’t work, instead of ever thinking that maybe the diagnosis wasn’t correct and there was an actual medical issue combined with actual issues that occurred that therapy could help with instead.

[annetteyoutube]

6:50 "Something has happened (to psychiatry) over the past several years in which we have given up therapy, and we're doing mostly medications."
--> Perhaps it's lobbyists and pharmaceutical companies?

[MBY]

זו מקצועיות ואנושיות. לומר את גבולות הידע במקצוע. ואת הפער בין המצוי לרצוי. כל הכבוד.

[terrybu]

This is an amazing video by Dr. Carlat ... Hi Dr.Carlat, I've incorporated your valuable teachings into my own nonfiction work dealing with my family's experiences with depression and how little help we received from psychiatrists at the time who blamed everything on "chemical imbalance in the brain' and kept pushing us Lexapro without adequate therapy ... i really appreciate this work and Dr. Carlat

[sheilasmith]

I retired in the fall of 2017, after 32 years as a psychotherapist, an LCSW, to be precise.
Diagnoses are subject to fads. For years every patient was BPD, then it was Major Depressive Disorder, then it was ADD.
For the last 10-15 years it has been Bipolar Disorder, ADD and PTSD.
3 things to consider: 1. A diagnosis is a subjective opinion by the therapist or doctor 2. For the provider to be reimbursed by insurance, there must be a DSM IV-V diagnosis. 3. A diagnosis, does not inform what treatment is best. It's just a subjective label that describes a cluster of symptoms, which may or may not be accurate.
PTSD: If it seems reasonable that PTSD is an accurate diagnosis, the most effective treatment ( studies indicate) is EMDR ( go look what it is) BUT, this treatment must be done by a therapist trained in EMDR, and a very specific protocol must be followed. Unlike other therapies, a create approach, should never be used with EMDR; no improvising.
Bipolar: 1st, in actuality, it's among the rarer mental illnesses, despite the fact that huge numbers of people self diagnose or treating practitioners diagnose. All individuals that experience chronic anxiety will also experience some depression. It's a natural cycle. This does not mean the person has Bipolar. Bipolar has very severe and prolonged mood shifts. The body will shift from the one extreme or to the opposite mood. It's natural, although a troubling process of homeostasis.
Find a therapist that is looking for underlying causes, rather than symptom relief. Find a therapist that will provide on visit 2 or 3, what the treatment plan is. What will successful treatment look like, or in what way will the patients day to day functioning be different?
This is why the goal of the patient is important to establish early on. If the moon is your goal, you will need a rocket ship, NOT, a bus.
A lack of a definitive goal is the single most frequent cause of treatment failure.
The therapist purpose in not to listen, nod, hold your hand, while repeating, " I understand." Treatment sucess depends on a dynamic interactive relationship, with observable change.
I conclude with this: An effective therapist has far more talent than skill. They intuitively understand human nature, are the best detectives, and are dedicated to resolving the root cause.

[Feline-philosopher]

I work as a social worker in Scandinavia. It has taken me a long time to question the treatment regime that i paricipated in. I am more sceptical today, and i dont envy the job of a psychiatrist, especially if you are a person with integrity. There is a whole lot of shame and denial in this critical field. My experience is that change only comes from significant healthcare/judicial reform.

[RomeshSenewiratne-Alagaratnam]

He said he worked for Wyeth "pushing" Efexor. Refreshingly honest. His candour is commendable as is his promotion of talk therapies and his explanation of the faults of psychiatric obsession with drug treatments, but he remains a true beliver in the flawed disease label model of psychiatry.

[Juliemadblogger]

Thank you. I recently fled the Boston area, where Harvard rules the medical scene and seems to be expanding. I, too, was whistleblower. There is no protection for patient whistleblowers. They usually arrest us or commit us to institutions. I know the medical regime terrorizes any doctor who speaks out. I feel sorry for those doctors who are helpless to change things for fear of retaliation.

[TIMESAYEAR]

I wish people would realize that a pill isn't going to fix any emotional problems they may have; it won't fix relationship problems. Depression is part of the human condition.We're supposed to have emotions and sometimes they get the best of us, but they are not "mental illnesses". I appreciate so much psychiatrists and psychologists exposing the myth of biopsychiatry. Something can be going on in a patient's life that is a real, physical problem (like a next door neighbor making noise at all times of the day or night causing sleep deprivation) but when the doctor has a conflict of interest, they will say that you're suffering from psychosis, i.e., you're hearing things that aren't real and try to make you take an anti-psychotic which will make you sick and do nothing about the problem. Unfortunately primary care physicians think that they should be able to prescribe and "diagnose" these drugs as well. People buy into this model, too, denying any relationship issues they have, or any behavioral problems they need to take responsibility for.
Btw, I would like to know how doctors can tell when something is a learned behavior (as I have seen in myself and others when they tell me about their parents' behaviors) and inherited conditions. The truth is they can't. The truth is it's most likely learned behavior.

[jy]

This is an honest attempt to tackle an all too common problem. i speak from experience as a qualified therapist who has experienced both sides of this coin ---- I qualified in 1957 --- Oxford --- then accidentally was drugged for five years on Lithium --- in 1981 - 1986 - then six years on
Monosodium Glutimate with dire results in 2007 --- since June 2020 have had no NHS support ---- no-one's fault ---- but over 40 years of stress is taking its physical toll --- too much to describe here but I have my medication in a dossette box that describes me as a "suitable container' for the drug barons. May GOD have mercy have mercy on them --- it is never too late. Or is it ?

[tinamahler-worth]

How do the psychiatrists themselves feel about being mostly just pill pushers? I think they would be yearning for a larger role.

[clemdane]

Effexor is awful. I was on it for a while and it was nearly impossible to get off of. I don't think it actually helped me, but it created a dependency in the form of the violent withdrawal symptoms that taking the drug for a while creates. Bear in mind these withdrawal symptoms have nothing to do with losing any good effects that it had on the underlying depression. These are drug-created withdrawal symptom that made you stay on the drug only because you can't face the long period of unpleasantness that it took to get off the drug. One doctor told me it would likely take a full year until I had recovered from the withdrawal effects. He was right. I lived in fear of losing my job and not being able to get the prescription anymore.

[jbisntme]

This man is very brave. He is 100% correct.

[sheilasmith]

The move away from psychotherapy happened with the HMO intrusion into the field. It was a cost reduction move by insurance companys.

[chrismattravers]

A fascinating and enlightening lecture!

[debrajanzen]

Enlightening! I appreciate Dr. Carlat's honesty.