I couldn’t get home last week from Los Angeles because of the snow storm so I flew into Las Vegas to do interviews for my new nonfiction book. I enjoyed being in the only city in America, I think, that didn’t have snow on its streets or freezing weather. It also was interesting to drive along the famous Strip and see how much it has changed from when I did my research in 1997 for my book, Super Casino.
While the Luxor is still there with its shiny black exterior and brilliant pyramid tip, it looked puny compared to the new billion dollar mega-resorts that have been constructed recently.
One thing that hasn’t changed is the contrast that you see in Las Vegas, even when you’re trying to find things to do in Las Vegas with kids.
Because it was Valentine’s Day weekend, the Strip was mobbed with young, carefree couples having a non-stop party. As I entered my hotel one night, I also spotted a middle-aged woman who looked as if she were homeless. She paused at the hotel entrance to examine the outdoor ash tray, searching through discarded butts until she found the remnants of a cigarette that still had a few puffs in it. She snatched it up, brushed off the black sand, and lit it.
I followed her into the casino and noticed that she stopped at the high roller slots where she stuck a $20 bill into a $5 slot machine and began pressing the spin button. As soon as the wheels stopped, she pressed it again, hardly waiting to see if she had won or lost. Within minutes, she was back on the street panhandling.
Like I wrote, a city of contrasts.
When I checked my laptop computer in my room that night I found a note from a friend who was frustrated because his daughter had been diagnosed differently by two professionals who were trying to help her. One of the professionals was a psychiatrist, the other a psychologist. With their different diagnoses had come much different treatment protocols.
My friend asked me if it was common for psychologists and psychiatrists to disagree about a diagnosis.
Which makes me wonder: Have you had this problem? Have you been given different advice by a psychiatrist and a psychologist? If so, please share your story and how you resolved the professional disagreement.
About the author:
Pete
Psychologists are about talk therapy. Pscyhiatrists are about drugs.
It is as simple as that.
But do Psychologists prescribe medications too?
Psychiatrists are able to prescribe medications, but that's not all that we do. Not at all. I learn something new about the person I'm with just about each time we meet and get a better understanding of what the problem really is. Thorough diagnostic evaluation should be important to both psychologists and psychiatrists. Mental status examination, historical information, collateral information from family if available are all important. Sometimes, it takes more than one session to accurately determine what is going on diagnostically and the diagnosis can be revised over time. Typically, psychologists have worked in collaboration with us. What we would not want to see is the psychologist making recommendations about medications. That is in the medical field, not the psychology field.
Mental disorders are very difficult to diagnose. It takes a really great psychiatrist to pinpoint a problem. When it comes to medications, the problem that I see is not psychiatrists but general practitioners. If a teacher tells parents that their child is hyperactive, then the parents tell that to their family doctor and he writes out a prescription for a medication that the pharm industry has pushed on him. We should only allow psychiatrists to issue prescriptions for psychotropic medications. That would prevent a lot of kids from being on medication needlessly.
One of the best ways of having both the psychiatrist and psychologist (or therapist, clinician) in sync with one another's decisions while working with a client with a severe mental illness is assertive community treatment (ACT) program. Both the psychiatrist and the clinicians on the team meet every day to review what they learned when they met with the clients during the week (meetings usually occurs right in the client's homes or somewhere else in the community, not in an office). This combination helps the client to be more involved in their own treatment decisions as well as having members of their treatment (which could also include specialists in the following areas: drug & alcohol, vocational, peer specialist) well aware of their needs for possible changes in medications or other types of treatment.
There is a good lesson in the story of seven blind men and the elephant.
“From Wikipedia, The story of the blind men and an elephant originated from India. In various versions of the tale, a group of blind men (or men in the dark) touch an elephant to learn what it is like. Each one touches a different part, but only one part, such as the side or the tusk. They then compare notes on what they felt, and learn they are in complete disagreement. The story is used to indicate that reality may be viewed differently depending upon one's perspective, suggesting that what seems an absolute truth may be relative due to the deceptive nature of half-truths.”
There are many different disciplines of psychology with varying opinions.
The main stream medical model of psychiatry, those you refer to as “pill pushers”, tend to overlook safe, effective treatments, as well as they ignore underlying conditions that manifest as mental illness.
Many patients dx with mental illness should be seen by neurologists, endocrinologists, nutritionists, etc., to correct/treat the medical condition that is making them appear “Crazy”.
For example, most psychiatrists would have dx Susannah Cahalan as schizophrenic and treated her with medications for the rest of her life. It took the persistence of her family to find a neurologist to discover the underlying condition and treat it effectively.
There are other less recognized branches of psychiatry, like Orthomolecular Psychiatry, based on principles developed by Dr. Linus Pauling and Dr. Abram Hoffer, that use vitamins, minerals and supplements to control symptoms of mental illness.
I highly recommend Dr. Scott Shannon's books. “Please Don't Label My Child” is an excellent book from the point of view of an Integrative Psychiatrist. His book is a must read for any parent whose child has been labeled “mentally ill”. Dr. Shannon has made his books available to the International Center of the Study of Psychiatry and Psychology bookstore at icspp.org.
Dr. Scott Shannon is one of the few psychiatrists in the country who has the complete picture and I highly respect him for his efforts.
At this point you should really consider taking some college courses in abnormal psychology, human anatomy and physiology, and nutrition so that you have a better understanding of mental illness.
Unlike your other books, most individuals who read Crazy are looking to you for “expert” advice. While I respect your efforts, I interpret Crazy as very supportive of the medical model approach of “pill pushing” with no consideration of the harmful effects psychiatric medication have. You also disregard what benefits complimentary medicine has to offer.
I can understand your position as a concerned parent, but look at how the parents of Rebecca Riley turned their four year old child into a “zombie” at the advice of a “pill pusher”.
Perhaps if you were the one experiencing the horrific side effects of psychiatric medications, you would take a lesson from the blind men and start thinking outside the pill bottle.
I realize this conversation is old. However, I found it as I was likening our experience with searching for treatment for our son, who has difficulty sustaining attention (not hyperactive), and has had an abnormal EEG (he was described as having Benign Childhood Epilepsy with Occipitol Paroxysms) to the Blind Men and the Elephant. Everyone seems to want to look at the situation from their specific area; make it fit into their area of diagnosis and treatment, without seeing the whole picture – or in this case, the whole child.
As with all medical practice, diagnosis is an art, not a science.
Considerable overlap exists between many of the diagnoses listed in the DSM-IV-TR (the “bible” of mental disorders). Even the best diagnosticians can be wrong, especially with a first-time assessment. Many mental disorders have more than a 50 percent incidence of comorbidity with other mental disorders. You asked what other parents would do in the same situation, if they were given conflicting diagnoses. As a mental health professional, the parent of a dually diagnosed child, and co-author of Selecting Effective Treatments: A Comprehensive, Systematic Guide to Treating Mental Disorders, I would first ensure my child's safety (is there suicidality? self-harm behaviors? etc.) Then, I would learn as much as I could about my child's symptoms, the latest research, diagnostic criteria, and evidence-based treatment options. Then I'd look for a specialist with that particular skill set. In many mental illnesses medication management combined with cognitive behavioral therapy is the preferred mode of treatment. Medication management should be done by a psychiatrist (not a family physician) while CBT or other forms of therapy can be done by a licensed professional counselor, social worker, or psychologist.
As with all medical practice, diagnosis is an art, not a science.
Considerable overlap exists between many of the diagnoses listed in the DSM-IV-TR (the “bible” of mental disorders). Even the best diagnosticians can be wrong, especially with a first-time assessment. Many mental disorders have more than a 50 percent incidence of comorbidity with other mental disorders. You asked what other parents would do in the same situation, if they were given conflicting diagnoses. As a mental health professional, the parent of a dually diagnosed child, and co-author of Selecting Effective Treatments: A Comprehensive, Systematic Guide to Treating Mental Disorders, I would first ensure my child's safety (is there suicidality? self-harm behaviors? etc.) Then, I would learn as much as I could about my child's symptoms, the latest research, diagnostic criteria, and evidence-based treatment options. Then I'd look for a specialist with that particular skill set. In many mental illnesses medication management combined with cognitive behavioral therapy is the preferred mode of treatment. Medication management should be done by a psychiatrist (not a family physician) while CBT or other forms of therapy can be done by a licensed professional counselor, social worker, or psychologist.