I've lost 2 people I know to suicide in tech. I've known others who've come close. We need to do something about it. What, I don't know, but mainstream psychiatry isn't that effective.
Why do you claim that mainstream psychiatry is ineffective? How do we know that people simply aren't taking advantage of mainstream psychiatry (to the degree necessary)?
The idea that there is one "mainstream psychiatry" is somewhat naive. It varies quite a bit from country to country, and the US does it somewhat horribly.
Don't take my word for it, the man who chaired the committee for the DSM-V thinks so (nd he wrote a book about it called "Saving Normal". Regardless of what you think about psychiatry from a theoretical perspective (e.g. what studies show), there is a MASSIVE gap between what practicing psychiatrists do and what happens in studies. As a country we are over-diagnosed (the DSM says x% of the population will have a given condition based on clinical research, yet somehow a massively larger # of people will be prescribed pills for it due to incompetent doctors and drug company advertising..
On top of that we have almost no idea what the mechanism of action is for any of these drugs. We take people, let's look at veterans for example, who have gone through traumatic events and say: "I guess going through that war there messed up some chemicals, take these!". It turns out there is a lot more in the way of treatment than just pills. At the same time these people are living in the streets and have no connection to community or family. There are more dimensions to mental illness than just chemicals in the brain. Here's an interesting non-pill related approach that's apparently helped some vets who were beyond treatment from pills ( http://www.nytimes.com/2016/01/31/magazine/what-does-a-parro... ).
Here's another example, in convenient peer-review form "The findings, from by far the most rigorous trial to date conducted in the United States, concluded that schizophrenia patients who received a program intended to keep dosages of antipsychotic medication as low as possible and emphasize one-on-one talk therapy and family support made greater strides in recovery over the first two years of treatment than patients who got the usual drug-focused care." http://www.nytimes.com/2015/10/20/health/talk-therapy-found-...
Unfortunately I can only open the door here, the material is complex and voluminous. I do encourage you to research and read on your own. The foundations of mainstream psych in American are shaky, and drug companies truly have an undue amount of influence in shaping research and policy.
It's not so much ineffective as insufficiently effective. At least for mood disorders, most patients need to try more than one treatment regimen before finding one that works (in the sense of having a sustained and appreciable reduction in symptoms without intolerable side effects), and a substantial minority never find a treatment regimen that they're satisfied with. The biggest study on this that I know of is STAR*D, which focuses on depression treatments [1].
A lot of people who commit suicide are typically on antidepressants and seeing therapists. Yet they never report this in the media. Antidepressants even carry a black box warning they can increase suicidal thinking.
Wouldn't surprise me if half the valley was on meds of some kind.
Psychiatry is mostly based on an unproven hypothesis of chemical imbalance in the brain. Of which there's no actual scientific evidence to back up this claim. In fact, studies have concluded antidepressants can cause imbalances where nonexisted before, and can cause severe life threatening withdrawals if you stop taking them suddenly.
Psychiatry is a pretty flawed practice in my opinion as well. I'm sure it helps some people, but it also does a lot of harm as well.
> A lot of people who commit suicide are typically on antidepressants and seeing therapists.
A lot of people die in emergency departments under the care of doctors. There's a reason for that that has nothing to do with the ability of the doctors.
> Antidepressants even carry a black box warning they can increase suicidal thinking.
Which is in part due to the unscientific (but legally sound) way that such side effects are attached to these drugs. I'm less concerned with the fact that they are labelled thusly and more concerned with the fact that in some cases there have been statistical increases in suicides. Yes, that is a problem, but you're both separating that out of the larger picture of pharmaceuticals and dumping it in with psychiatry in general.
> Psychiatry is mostly based on an unproven hypothesis of chemical imbalance in the brain. Of which there's no actual scientific evidence to back up this claim.
This is an incredibly bold claim with no actual scientific evidence to back it up. There is, in fact, a lot of science backing up psychiatry and psychology (entire journals). Their experiments use widely accepted techniques that are also used in other sciences, like biology and medicine.
> In fact, studies have concluded antidepressants can cause imbalances where nonexisted before,
No study has made this blanket conclusion. Perhaps some studies have reached this conclusion about a specific class of anti-depressant or a single anti-depressant.
But you can't use that as evidence that psychiatry is flawed. First, anyone in medicine who can prescribe medication can prescribe antidepressants even if they aren't trained in psychiatry. Second, many medications can cause problems in our systems; it's why we have the prescription system in the first place. Antidepressants are not unique in this regard and therefore do not reflect on psychiatry in the specific.
> and can cause severe life threatening withdrawals if you stop taking them suddenly.
Just like many other pharmaceuticals, some antidepressants can cause withdrawal symptoms when the patient is not weaned off the medication properly. Noncompliance is a problem in ALL medicine. In the realm of mental illness there is also the problems of stigma and lack of proper insurance coverage both of which can create additional problems with compliance.
> Psychiatry is a pretty flawed practice in my opinion as well. I'm sure it helps some people, but it also does a lot of harm as well.
I won't see anyone without a Ph.D. A Ph.D. means they've done some science. But (just as with MDs),it's no guarantee that they're critical thinkers and scientists when they get out into the world and practice. But mine can cite papers, recommend reading, form reasoned opinions, and his Ph.D. thesis is impressive (I asked to see it).
I suspect you're largely judging the field from the current state of affairs: massive stigma, poor insurance coverage, and mediocre practitioners who are quick to write prescriptions but slow to make sure the long term healing is done. Find a psychiatrist, psychology, MFT, or whoever through your average insurance plan and you're more likely than not getting a counselor more than an actual therapeutic healer.
But these are largely economic and social problems, not a question of the effectiveness of the healing.
No, obviously not. But "don't just stop taking your meds" is on the patient information leaflet for every ssri / snri / nasa / etc style anti-depressant because suddenly stopping is significantly risky. (For some of them, eg venlafaxine, it's pretty unpleasant too.)
Antidepressants commonly cause suicide by treating the physical retardation symptoms of depression before treating mood symptoms. If someone is so depressed they can't get out of bed, then starts taking an antidepressant, they might continue to be just as depressed, but now have the energy to get out of bed. This is especially common with teens.
SSRIs definitely do work for some people, but the mechanism isn't well understood and is well-researched. There is plenty of actual scientific evidence to back up the serotonin imbalance hypothesis, but of course no amount of evidence can ever prove a theory true. There are other findings that indicate other theories -- my personal favorite is that the antidepressant effect of SSRIs is from incidental neurogenesis, and NSI-189 looks promising as the first of hopefully many antidepressant drugs coming from this theoretical basis entirely.
While a lot of people who commit suicide are being treated for a mental illness, the majority of people who complete suicide (i.e., actually kill themselves) are not in any sort of treatment. Suicide is actually a very impulsive behavior in most cases. For this reason, if you make the means of suicide less available (putting fences up on bridges, gun control, etc.), you actually decrease the incidence of suicide even though there are plenty of ways people can kill themselves.
A few nits to your post:
* Psychiatry isn't based on a chemical imbalance hypothesis. SSRIs, and some other drugs, are. Psychiatry as a whole is far too wide to be based on any particular theory, except maybe probabilistic determinism (the assumption that events have causes that can be used to predict the future).
* Psychiatrists are medical doctors with a specialty in mental health. "Psychiatry" is not a very well-defined area, and usually indicates the speaker is a Scientology crank. The actual field you discuss in your post is psycho-pharmacology. You don't comment at all on diagnostic procedures, which is a major non-pharmocological component of a psychiatrist's job, nor on non-pharmocological therapies, some of which have been very well-studied and indicate to the best of our scientific ability to be reliably positive mental health interventions.
As a final note, it wouldn't surprise me if all of the Valley, and indeed most of the world, was on "meds" of some kind. Most people drink. A lot of people smoke. Marijuana is legal in California and is going to be legal soon in the general case. Video games exist that are thin wrappers around psychological reward pathways, and are functionally equivalent to drugs, even if they don't involve ingesting or inhaling anything. There are very few "pure" humans. The question isn't whether or not someone is "on meds," but whether they're getting what they need as a person to self-actualize.
PS: I recognize I have made a number of factual claims in this post. I have not included any links to scientific papers because it took long enough to type out and I didn't want to spend twice as long digging through sources. I'll provide the papers I thought of while writing this, but only under one condition: anyone asking for them shows convincing (to me) evidence that they have looked for these sources on their own. I help those who help themselves.
You need to cite that "common" claim there, and balance it against the numbers of deaths by suicide that are prevented by appropriate anti-depressant use.
Oh, it wasn't my intention at all to imply that antidepressants commonly cause suicide. When antidepressants are involved in completed or attempted suicide, that is the cause. Antidepressants are prescribed because they usually work, though since most suicides are impulsive, it's unclear how many suicides antidepressants prevent.
Psychiatry is at the bottom of a deep pit. My hope is Millenials live long enough for this profession to pull itself back, at least half way up.
We were lied to about the effectiveness of SSRI drugs by the drug companies. Psychiatrists were as much victims as their patients. I don't blame Psychiatrists. I have the look on my Psychiatrist face imprinted, when I sat in that chair, and told him "That drug did nothing." It got to the point where I felt like lying. "It kinda worked?" But I didn't. It was my life--I wanted to get better.
I finally found a drug that worked, a little bit. I think that's the rub. You need to see a Psychiatrist to find a drug that works a little bit. Keep in mind that drug might be habit forming, so only go if you are certain your condition is Not Situational.
If your psychiatrist just offers SSRI's, ot tricyclics; find another Psychiatrist. If you do find a drug that seems to work, be prepared for mandatory office visits. They need to make a living. (These drugs should be regulated differently, but that's another fight. By regulated, I mean, if you are on a long term drug; you shouldn't have to see a psychiatrist to get refills.)
If I was to do it over again, I'm not sure I would take anything, but my anxiety was not situational. It came from "I have no clue. Just life?". I have found controlled use of alcohol helps. Try to keep the alcohol to a minimum. Two drinks for a panic attact. Don't drink socially. You are drinking to control that busted gasket. It needs time to heal. An understanding family really helps.
I have said this before, and I have no reason to lie. You will get better with time.
I have gotten to read my Psychiatrists face/non-verbal tells. I believe it when he says "Anti-depressants do work for some of my patients." I've looked into the litature, and they might help some really depressed patients? Might? If you are seriously suicidial go to the hospital. Don't rule out ECT. (Use it as a last resort, but don't kill yourself. Emergency room personal are prepared to deal with psychiatric emergencies.)
And again, if you are reading this and just not feeling right, a little dizzy, just not right; you will get better with time.
As to the original question; No--mainstream Americans does not need to see a Psychiatrist. Most good Psychiatrists only want to see the patients who don't respond to a Psychologist's therapy.
As to therapy--give it a shot, I guess? I found it completely useless. I think they did more damage to a once innocent twenty something mind? They might have changed? My psychologist was a Freudian. I remember making an a appointment with another Psychologist. "What's your reason for seeing Dr.whatever?" Me, "I was told I have a Electra Complex." Office, "A what?" It's funny now.
Good luck! If you know someone fighting these problems, don't give offer them worn our clichés. Whatever you do, don't take advantage of a wounded individual. I was financially abused at my worst. Will never forget that retched person.
One of the problems with mainstream psychiatry is that it does not work to pay someone to care. It also does not work to pay someone by the hour for this type problem rather than paying them for results.
I don't know how to fix it. I do think military shrinks have a better track record. They are still employed, even if you get better. They don't have an inherent incentive to want you to keep being in need of "help" so they can finance a second home or some shit.
Good therapists are overbooked and have waiting lists for new patients. They will be the same number of hours even with substantially less contact per patient.
For all the faults and limitations of mainstream psychiatry (which are varied and substantial), it's pretty much the only game in town with a verified track record. Arguments against mainstream psychiatry are a dime a dozen, but arguments for alternatives tend to be fluffy philosophical assertions and broad-brush accusations of misconduct rather than real-world demonstrations that something else works significantly better (with N >> 1, of course).
On the upside, psychiatry and neuroscience are beginning to merge. The disease model of mental illness is such a poor abstraction. And diagnostics in psychiatry is mostly contained to subjective self-reported symptoms. And then treatment is basically a crapshoot; trial and error with antidepressants that don't have well understood causative mechanisms.
As neuroimaging becomes ubiquitous and cheaper, it will replace self-reporting as the primary diagnostic tool. At which point we'll be able to do away from the 'DSM disease model' and actually see which 'neural circuits' are dysfunctional. Consequently, medication will be better calibrated and targeted.
I really think we're on the verge of a psychiatric revolution, and will all be better off as a result.
It would be more accurate and insightful, I think, to note that psychiatry is the attempt at a verified track record. It's not so much that it is the only game in town as it is the result of recording our attempts in a coherent fashion.
Its failures point to the difficulty of the problem more than anything.
