Interesting that a person of legal age is given medications and treatments to help resolve their mental illnesses. Yet in todays’ psychiatric field, patients under legal age are not helped with their mental illnesses but affirmed in their abnormal beliefs ( if it is the correct belief in line with the facility). Children are castrated, sterilized and surgically mutilated by the “medical professionals” without a word from psychiatrists.
But… if a child identifies as anorexic…. The child is NOT allowed to have liposuction or gastric bypass if they request it.
What if the child identifies as a pirate ??? Is the correct tx an amputation of a leg to fit a wooden peg-leg? Removal of an eye to justify a patch or hand to apply a hook?
Many health professionals- i hazard to say most- are upper-middle to upper class. Adherence to the tenets and dogma of gender ideology are a kind of class-based religion, and so i do not anticipate any great awakening among the medical profession as a whole, any time soon.
Dr. Greenwald, I would love your take on the much less talked about side effect of psychiatric medications - sexual dysfunction. I keep hearing about PSSD from some patients on therapy. How is the evidence base on Post-SSRI sexual dysfunction as an iatrogenic harm caused by psychiatric medications? Thank you so much for your compassionate and enlightening articles. I enjoy reading and learning from them.
I saw your comment yesterday, and came back today to see if it had been responded to. I find doctors are uncomfortable discussing iatrogensis because in a sense they have to dissociate from the harmful effects of the strong drugs they prescribe, whether psychiatric or oncology as examples. Their training is in using these types of drugs, and they have no awareness of anything that may be safer and efficacious. Many would argue such things don't exist.
Thank you for your response. Well put. When I questioned my PCP about some harmful side effects of a drug she prescribed, she brushed it away and wrote a note on my epic that I showed signs of medication hesitancy for fear of side effects. I ended up asking this to Dr. Google after my appointment. Well, now we can ask ChatGPT and hope it would be more accurate than the answers in reddit forums. We still prefer the human component for sure.
Using that label of showing "signs of medication hesitancy for fear of side effects" is a disgraceful, undignified and patronising way to treat a patient. But again, they need to dissociate, hence easier to suggest problem is yours rather than theirs. There are wholistic systems of medicine that treat you as a whole person and not one that comprises different parts.
I enjoyed this piece, and learned from it, but I have a question. Is it ok for a doctor to be publishing his patients' private writings and drawings online? Even using pseudonyms, as these seem to be? Just thinking from the perspective of the patient -- if I shared my personal writing with my doctor, I might not expect (or want) him to share it with the world. I'm just a curious reader, not a medical professional, so maybe I don't understand the situation, but this made me a bit uncomfortable. Did the patients agree to have their work included here? The essay didn't make that clear.
Yes, I always ask permission to keep anything my patients write or draw, as well as make sure they are OK with it being used for publication provided it is sufficiently anonymized.
All doctors should ask for their patients to draw and/or write for them. It seems there's a lot than can be discovered through that. All these patients' experiences are heartrending. I worry about Donald. Dementia is hard and scary and will eventually need accommodations, he shouldn't be alone.
I’d wager that one of the most significant factors determining a patient’s outcome, aside from disease severity and blind luck, is whether they have caring family and friends to help them. No doubt.
Thank you for your thoughtful and fascinating look into psychiatric medicine. I too enjoy these posts!
The segment about Trisha really resonated with me. I worked on a labor and delivery unit in an inner city hospital that catered to a wide range of patients, including indigent. I remember well an incidence of a laboring woman who was in and out of psychosis on our unit. She wanted to go outside and smoke a cigarette. But going outside as a laboring, psychotic patient was forbidden. Her OB doc forbade it, her nurse forbade it and the psych doc on call forbade it. Which escalated to her losing control to the point that hospital security and the city police were called. I was working charge that day and decided to take a different approach. Why not accompany her outside and let her have the cigarette? As a former smoker I know in times of stress, that a cigarette could do wonders. I told her I would walk out with her and remain while she smoked but she needed to trust me and not make a scene. We walked out together and that's exactly what transpired. Was I lucky or did I just allow a human being the simple act of going outside and smoking a cigarette?
Sometimes I wonder if we don't make crazy patients crazier. It was the right thing to do.
It was the right thing to do. When I worked in the criminal court system with MI adults, we did these kinds of things often and I do not recall any negative result. I sometimes walked people 2-3 blocks to the hospital, let them smoke, talked about anything but court or the hospital, and none ran off. When people are restrained and having an episode, there's nothing worse than a windowless, enclosed space and a bunch of law enforcement, but that is what many MI people are subjected to because our legislators would rather pay for prisons than treatment. It's a horrible thing to sit on a cold jail cell floor next to a sobbing psychotic woman, naked except for a green restraint "pickle" suit, trying to help her make sense of something that makes no sense. And treatment that's mandated without any consequence for failure to follow through is often useless. Civil courts need to be able to deal with initial refusal of treatment rather than wait until the mentally ill are in criminal custody and they have to answer to probation officers and criminal judges.
Thank you for sharing this Dr. Greenwald. It reminds me of my days working in a locked unit. I miss that. The mind is a fascinating organ with so many woven pathways and junctures. Different diagnoses taking you down roads never before examined. I can't imagine living in a world of such terror and darkness not ever seeing any light at the end of the tunnel.
I've let my Sensible Medicine subscription go, but these posts are the ones I will miss when it runs out. Thanks for this window into your work and the human mind, Dr. Greenwald.
Very interesting. But , I winder, do you ever employ a graphologist? I am not a gtaphologist, but I know that whete I livr ( France) they are often employed not only by hospitals but the courts too. I ask this because - excuse me saying so - just the style of the hand writing suggests to me a level of immaturity. But the I have nothing to compare it with , as in what would be the style of hand- writing of the average person in the U.S.A.?
If I were to look at those exceptionnel knowing nothing, I would probably think they were written by a child.
Interesting idea, but I think Nadia already correctly said that another culprit that we are no longer taught proper handwriting.
That said, there has been some investigation into correlations between handwriting abnormalities and the onset of psychotic disorders. I haven’t reviewed that literature in detail (thank you for the homework!) but if I had to bet, i’d say that with sufficiently discriminating tests, we would in fact be able to find motor abnormalities in those with psychotic disorders.
As you can see, one of the patients' has tremors, so writing 'maturely' isn't so easy in their case. People don't get schooled on how to write pretty here. At least not in my time!
Interesting that a person of legal age is given medications and treatments to help resolve their mental illnesses. Yet in todays’ psychiatric field, patients under legal age are not helped with their mental illnesses but affirmed in their abnormal beliefs ( if it is the correct belief in line with the facility). Children are castrated, sterilized and surgically mutilated by the “medical professionals” without a word from psychiatrists.
But… if a child identifies as anorexic…. The child is NOT allowed to have liposuction or gastric bypass if they request it.
What if the child identifies as a pirate ??? Is the correct tx an amputation of a leg to fit a wooden peg-leg? Removal of an eye to justify a patch or hand to apply a hook?
Just my thoughts on modern psych medicine.
Many health professionals- i hazard to say most- are upper-middle to upper class. Adherence to the tenets and dogma of gender ideology are a kind of class-based religion, and so i do not anticipate any great awakening among the medical profession as a whole, any time soon.
Dr. Greenwald, I would love your take on the much less talked about side effect of psychiatric medications - sexual dysfunction. I keep hearing about PSSD from some patients on therapy. How is the evidence base on Post-SSRI sexual dysfunction as an iatrogenic harm caused by psychiatric medications? Thank you so much for your compassionate and enlightening articles. I enjoy reading and learning from them.
I saw your comment yesterday, and came back today to see if it had been responded to. I find doctors are uncomfortable discussing iatrogensis because in a sense they have to dissociate from the harmful effects of the strong drugs they prescribe, whether psychiatric or oncology as examples. Their training is in using these types of drugs, and they have no awareness of anything that may be safer and efficacious. Many would argue such things don't exist.
Thank you for your response. Well put. When I questioned my PCP about some harmful side effects of a drug she prescribed, she brushed it away and wrote a note on my epic that I showed signs of medication hesitancy for fear of side effects. I ended up asking this to Dr. Google after my appointment. Well, now we can ask ChatGPT and hope it would be more accurate than the answers in reddit forums. We still prefer the human component for sure.
Using that label of showing "signs of medication hesitancy for fear of side effects" is a disgraceful, undignified and patronising way to treat a patient. But again, they need to dissociate, hence easier to suggest problem is yours rather than theirs. There are wholistic systems of medicine that treat you as a whole person and not one that comprises different parts.
I enjoyed this piece, and learned from it, but I have a question. Is it ok for a doctor to be publishing his patients' private writings and drawings online? Even using pseudonyms, as these seem to be? Just thinking from the perspective of the patient -- if I shared my personal writing with my doctor, I might not expect (or want) him to share it with the world. I'm just a curious reader, not a medical professional, so maybe I don't understand the situation, but this made me a bit uncomfortable. Did the patients agree to have their work included here? The essay didn't make that clear.
Yes, I always ask permission to keep anything my patients write or draw, as well as make sure they are OK with it being used for publication provided it is sufficiently anonymized.
All doctors should ask for their patients to draw and/or write for them. It seems there's a lot than can be discovered through that. All these patients' experiences are heartrending. I worry about Donald. Dementia is hard and scary and will eventually need accommodations, he shouldn't be alone.
I’d wager that one of the most significant factors determining a patient’s outcome, aside from disease severity and blind luck, is whether they have caring family and friends to help them. No doubt.
Definitely. All these conditions are difficult, having a good support system would at least make it less scary and lonesome.
Thank you for your thoughtful and fascinating look into psychiatric medicine. I too enjoy these posts!
The segment about Trisha really resonated with me. I worked on a labor and delivery unit in an inner city hospital that catered to a wide range of patients, including indigent. I remember well an incidence of a laboring woman who was in and out of psychosis on our unit. She wanted to go outside and smoke a cigarette. But going outside as a laboring, psychotic patient was forbidden. Her OB doc forbade it, her nurse forbade it and the psych doc on call forbade it. Which escalated to her losing control to the point that hospital security and the city police were called. I was working charge that day and decided to take a different approach. Why not accompany her outside and let her have the cigarette? As a former smoker I know in times of stress, that a cigarette could do wonders. I told her I would walk out with her and remain while she smoked but she needed to trust me and not make a scene. We walked out together and that's exactly what transpired. Was I lucky or did I just allow a human being the simple act of going outside and smoking a cigarette?
Sometimes I wonder if we don't make crazy patients crazier. It was the right thing to do.
It was the right thing to do. When I worked in the criminal court system with MI adults, we did these kinds of things often and I do not recall any negative result. I sometimes walked people 2-3 blocks to the hospital, let them smoke, talked about anything but court or the hospital, and none ran off. When people are restrained and having an episode, there's nothing worse than a windowless, enclosed space and a bunch of law enforcement, but that is what many MI people are subjected to because our legislators would rather pay for prisons than treatment. It's a horrible thing to sit on a cold jail cell floor next to a sobbing psychotic woman, naked except for a green restraint "pickle" suit, trying to help her make sense of something that makes no sense. And treatment that's mandated without any consequence for failure to follow through is often useless. Civil courts need to be able to deal with initial refusal of treatment rather than wait until the mentally ill are in criminal custody and they have to answer to probation officers and criminal judges.
Thank you for sharing this Dr. Greenwald. It reminds me of my days working in a locked unit. I miss that. The mind is a fascinating organ with so many woven pathways and junctures. Different diagnoses taking you down roads never before examined. I can't imagine living in a world of such terror and darkness not ever seeing any light at the end of the tunnel.
I've let my Sensible Medicine subscription go, but these posts are the ones I will miss when it runs out. Thanks for this window into your work and the human mind, Dr. Greenwald.
We will miss you!
Wow
Very interesting. But , I winder, do you ever employ a graphologist? I am not a gtaphologist, but I know that whete I livr ( France) they are often employed not only by hospitals but the courts too. I ask this because - excuse me saying so - just the style of the hand writing suggests to me a level of immaturity. But the I have nothing to compare it with , as in what would be the style of hand- writing of the average person in the U.S.A.?
If I were to look at those exceptionnel knowing nothing, I would probably think they were written by a child.
Interesting idea, but I think Nadia already correctly said that another culprit that we are no longer taught proper handwriting.
That said, there has been some investigation into correlations between handwriting abnormalities and the onset of psychotic disorders. I haven’t reviewed that literature in detail (thank you for the homework!) but if I had to bet, i’d say that with sufficiently discriminating tests, we would in fact be able to find motor abnormalities in those with psychotic disorders.
As you can see, one of the patients' has tremors, so writing 'maturely' isn't so easy in their case. People don't get schooled on how to write pretty here. At least not in my time!
I could imagine that's part of what he observes. They may be in a sense that age in their minds?