[Rossie]

...are....THERE TO HELP!!!

[nowheretorun]

where would i be without their help? the owner of this website is a psychiatrist... or is he a psychologist? i forgot the difference ...

Pdocs have done a lot to help us on the whole... i'm sure its like any profession, some members are less virtuous, but i would never scorn the whole...

our own Doc John Rocks.. he's a cool guy just cause he has this site... no one made him help us like this... i like to believe it comes from the goodness of his heart...

[teejai]

I wish i could believe you. I know they are supposed to be there to help but for the most part that hasn't exactly been my experience.

[nowheretorun]

i havent had an ongoing relationship, but i would say its instinctual to want to know whats inside the head.... for me at least... so these guys have spent a lot of time at it, kept records, networked, shared theories, published their ideas so i could come along and read about it... it helped...

did you ever read a psych article and learn from it? even if you disagreed you would have discovered the disagreement because you'd read the article. psychiatry helped you define your own beliefs...

Psychiatry is a specialist field within medicine (other specialist fields within medicine include neurosurgery, neurology, cardiology, pediatrics etc). Psychiatrists train to be medical doctors, and then specialize in a particular area (such as primary care, or psychiatry or whatever).

Psychology is a field within university departments (other fields include biology, sociology, chemistry, computer science etc). One field within psychology is abnormal psychology. People can train to be clinical psychologists and gain accreditation to practice as clinical psychiatrists - treating people with mental disorders. Other fields within psychology include social psychology, organizational psychology, neurological psychiatry, criminal psychology, and so on.

One way of capturing the difference is that psychologists treat by way of TALK THERAPY whereas psychiatrists treat by way of PHARMACOLOGICAL INTERVENTION (medications and psychosurgery). This distinction is blurring as some psychologists (neuropsychologists) have started to try and get licenses to prescribe medication (where prescribing medicine is typically something that only doctors are allowed to do). The distinction is also blurred historically, as Freud advocated a particular variety of talk therapy (psychoanalysis). It used to be the case that one had to be a MD (Medical Doctor) before one was allowed to train as a psychoanalyst - but now the doors have been opened to clinical psychologists and master of councelling people (a field within education) and social workers (not sure where that falls. Sociology?). Another historical distinction is that the birth of psychiatry as a specialist field is sometimes placed at the birth of the idea that the asylum could be THERAPUTIC in treating people with mental disorders. The idea that running an asylum in a THERAPUTIC manner took a MD with special attributes.

Doctor of Psychology (PsyDoc) is a fairly recent qualification. It contrasts with the more traditional Doctor of Philosophy - in Psychology (PhD) in that it is PRACTICAL rather than RESEARCH focused. Matter of ideology, really. Some people thought that training for research (e.g., learning how to conduct experiments, learning how to analyze statistical data and so on) wasn't necessary in order for one to be a good clinician. Indeed, that spending time learning those things was taking time away from the practice of psychotherapy. So... The PsyDoc qualification (non research academic doctor - if that isn't a contradiction in terms) was invented with the intention of providing much more hands-on experience / practicum with less emphasis on research. The idea is that that will enable the person to be a better clinician in practice.

The Boulder conference was the start of this (there was much debate - and the debate remains).

Part of the debate is over... Whether the Doctor of Psychology should be an academic qualification where what has traditionally been the main feature of a university qualification (as distinguished from a technical college qualification) is RESEARCH. But then... Similar issues arise with education, nursing, and indeed there are similar issues with law, engineering, medicine etc...

[nowheretorun]

i mean, teejai, even if i imagined a hypothetical world without psychiatry and all its problems, someone (probably me) would end up wondering 'what's going on up there?', and then, we'd have a world of psychiatry, right?

[nowheretorun]

what is the Boulder conference alexandra?

and im not supporting over medication in any way at all, just to clear that up....

> PhD Training Model

The scientist-practitioner model of training is represented in PhD clinical psychology programs. This model of training was first formally articulated in a report commissioned by the APA... And subsequently at a conference in Boulder, Colorado. It is typically referred to as the BOULDER MODEL of training in clinical psychology. Students are required to develop skills both as psychological researchers and as practicing psychologists. Although the balance of these two types of training activities is rarely exactly 50-50 in any single program, all Boulder Model programs share a committment to a relative balance of training in the science and application of clinical psychology...

The rationale for the balance of training in research and practice is that, regardless of the specific career they persue, clinical psychologists will need to draw on both sets of skills. For clinical psychologists who are actively involved in research, it is essential to be able to draw on experience working with people who have clinically significant problems. This experience keeps researchers in touch with the issues and problems that are faced by such people... Similarly, it is essential for clinical psychologists who are primarily involved in clinical practice to have a solid foundation in psychological research. Without training in research methods, practicing clinicians will be unable to stay informed of the latest developments in research so they can be educated consumers of the research advances that will emerge during the course of their career.

PsyD Training Model

Programs that grant a PsyD degree in clinical psychology to their graduates differ from PhD programs in the balance of training devoted to research and clinical practice. Although some PsyD training programs are based in universities, most exist in seperate freestanding professional schools devoted solely to the training of professional psychologists. In these programs, relatively little emphasis is given to clinical research and relatively more training is devoted to skills in psychological asesssment and intervention. Although students in these programs may conduct original clinical research for their dissertation, PsyD programs allow students an alternative to complete this requirement through other means, such as a review of the literature on a topic relevant to clinical psychology or a detailed case study.

The rationale behind practitioner-oriented models of training is twofold. First, there is a large body of knowledge and skills that a student needs to learn to become a competent clinician, and competence in the skills needed for clinical practice requires more time than can be devoted to them in a program that emphasizes both research and practice. Second, because most clinical psychologists do not go on to conduct research, they need relatively less training in research. Proponents of this model contend that it is no longer possible to acquire the necessary foundation of both clinical and research skills in the span of four to five years of doctoral training.

Introduction to Clinical Psychology: Science and Practice, pp18-19 (The book is, of course, biased towards the boulder model - as the title suggests).

[nowheretorun]

ok... found the connection i was looking for there.. it sounds like the model has some controversy... i would imagine there are other 'contender' models?

Those are the two main models in clinical psychology (they are models of how clinical psychologists should be trained). They are the main ones because the models result in two very different qualifications. Other qualifications aren't qualifications in clinical psychology.

There are many other conflicts between how we are best to treat people with mental disorder (gene therapy, neurological intervention by medication / psychosurgery, talk therapy, sociological intervention etc).

And there are many other conflicts between how we are best to conceive of mental disorder (genetic, neurological, psychological, social etc).

The trouble is (I think) that people are trained in one particular perspective and then their professional identity depends on that particular perspective being legitimate. There is a lot of professional rivalry over such things as which perspective is 'right' (has something to do with who the health insurers should fund for treating).

I like philosophy because it allows me to take a step back from all that... I'm not wedded to psychology or education or psychiatry or sociology or genetics or whatever having some privaledged grip on the conceptualisation and treatment of mental disorder. My professional identity remains intact whether some are illegitimate and others are legitamite, or whether all are legitimate or whether all are illegitimate... Doesn't make a damn to me (so I can try and figure out from my relatively detached place how the hell things seem to be).

The only thing I have to contend with is other reasons for prejudice that I might have (e.g., due to my experiences resulting in me making unwarranted generalizations and so on)...

[nowheretorun]

well ok, i get a clearer sense of the environment around how things tick from someone who knows....

its a massive industry, bound to be mis-communication, conflict of interest, opinionation, divisions....

i could draw a co-relation to a business that stands in its own way to progress in that the seperate departments each take their own interest as being primary....

too much going on in every direction and without a main arbiter there is only chaos..

so the current models are reviewed periodically i would guess? or, is it rather, still in growth and adaptations with an attending body?

Yeah, a similar thing can happen in university environments. The last university I was in was run under a business model. Different departments were given their own budget for hiring of staff and tutors and the buying of equipment. Revenue was generated from government funding (allocated on a 'number of students enrolled in classes' per department) basis, along with funding generated from 'number of publications appearing in a journal where the journals are ranked on the basis of impact factor per member of department'.

Science generates more revenue than arts (because impact factor is determined on the basis of citations and science cites more liberally than arts). Science also tends to generate more revenue than arts because more students take science for the better job prospect. Science also generates more revenue than arts because there are alternative sources of funding (e.g., from pharmaceutical companies, or from health research funding, or from the dairy board, or the defence department, or from the private sector etc).

(Typically universities take some of the revenue generated from the sciences and reallocate it to the arts. While it is true that science stuff costs more (lab equipment, machines, etc) it is still true that science is MUCH more lucrative. It is typical that science subsidises the arts. The way the university was going was an outrage... They weren't redistributing the funds from science to arts - the motto was 'every department for itself'. The people in power were from science, basically, and didn't give a %#@&#! about the arts (and didn't appreciate how strong arts departments are historically shown to be a precondition of creative sciences). Downward spiral... I was happy to jump ship.

The department that was doing the best was... ITS (Information technology support). They didn't run classes (indeed they are there to service the departments by providing internet and computer support). In practice... They were charging the particular departments for internet usage, however! They were raking in the funds. Even when... The university owned the server so server usage was free for the university - there was just a transfer of funds from one department in the university to another department! Arts was the worst off because arts students read a lot of stuff via online access. ITS had a monopoly and the prices for internet usage that was charged to the department was outrageous! (My department was paying $50 a week for my internet access - which was insane!)

Politics. Sigh.

The pharmaceutical industry has a lot of money hanging on the acceptance of the biological model of mental disorder. They heavily control the sciences by providing research funding to do the studies they want done and making the cost of obtaining pure samples of the patiented medications too expensive for people to run the studies without the pharmaceutical industry's funding. The science is quite severely perverted... It makes my blood boil...

There are different regulatory bodies that different professionals must be answerable to, yeah.
Clinical psychologists are answerable (in the US) to the American Psychological Association (for their registration / permission to practice as a clinical psychologist, for their professional guidelines etc)
Psychiatrists are answerable (in the US) to the American Psychiatric Association (for their regiatration / permission to practice, professional guidelines etc)

[nowheretorun]

well, as those who experience the reality of those labels, we have advocates, i get the picture though alexandra.. can be depressing and oppressing...

ive been stuck on this concept of transcendence... feels like i should start a petition or something but, i know thats being done too, so ?????

i think recovering is the best revenge? just kidding..

Well... There are good empowering reasons to view mental disorders as biological (it isn't my fault, i have a right to drugs that i would like to have). And... There are good empowering reasons to view mental disorders as not biological (I can learn how to change this, I am a responsible human being just like everybody else).

The anti-psychiatrists are just as much advocates (if not more so) for patient rights than the psychiatrists are...

[nowheretorun]

yeah, i think self help is a large industry as well when you add in the seminars, dvd's, book deals, tv appearances..

i see how a mix of services would have to be available to serve a wide mix of needs...

[teejai]

</font><blockquote><div id="quote"><font class="small">Quote:</font>
nowheretorun said:
i mean, teejai, even if i imagined a hypothetical world without psychiatry and all its problems, someone (probably me) would end up wondering 'what's going on up there?', and then, we'd have a world of psychiatry, right?

</div></font></blockquote><font class="post">


It's not psychiatry i have a problem with(I am not anti psychiatry) but (through negative experiences) those who put psychiatry into practice ie those who deal with clients/patients.

Ideally i would like to be able to have a reasonable amount of trust for such people but unfortunately interactions with them have so far not made that possible beyond a limited degree.

Probably if i had not had a very negative experience during my first ever hospitalisation or if on having that very negative experience
the mental health professionals had ever be decent enough to acknowledge that experience and reassure me i would have felt differently.

[nowheretorun]

teejai, im sorry, got involved talking with alexandra, didnt mean to invalidate your experiences, ive had screaming experiences with mental health workers... in my case, i could have been more patient, but, at times, the frustration builds to that point... i do hope things improve for you teejai...

[splitimage]

I have had great experiences with both psychologists and psychiatrists. I consider my primary MH caregiver to be my psychologist who is in private practice but splits her time 50/50 between clinical work and research/education. She refered my to my psychiatrist for meds management when she realized that my problems could not be solved through talk therapy alone. My first psychiatrist wasn't the greatest - I just wasn't comfortable with her clinical style, but I love my current pyschiatrist. I see her primarily for meds management but she also does some psychotherapy so I always see her for at least 50 minutes once a month. She's the clinical director of a women's inpatient program at the major psych hospital in my city and so has very few private patients, so I feel lucky to have her. And when I needed to go IP she got me in immediately and continued as my primary care psychiatrist while I was IP which was great and she coordinated with my psychologist while I was IP so I could continue seeing her too. I've been really lucky to get really good care. Basically having the mix of both has really helped me. I just wish private psychologists weren't so damned expensive - my insurance doesn't cover them and they're not covered under provincial medical insurance either - after rent she's my second biggest expense every month.

--splitimage

[(JD)]

The Ph.D. Defined
The Ph.D. is a doctoral degree, the highest graduate degree awarded in American universities. In the U.S., a Ph.D. program usually takes from four to eight years to complete.

M.D.-Ph.D. Programs
A number of medical schools offer combined M.D.-Ph.D. degree programs, which provide students the opportunity to earn both the M.D. and the Ph.D. in areas pertinent to medicine

Psychiatrists are doctors who specialize in the physical causes and effects of mental illness. Some focus on talk therapy, helping patients heal through talking about their problems, and others focus on treating illness with medication. Many combine these approaches.

Unlike psychoanalysts, who focus on the unconscious, psychiatrists who take a cognitive approach focus on the way their patients think about themselves and the world around them.

Many MDs do not feel comfortable dispensing prescriptions for psychotropic medications, and thus it's important to have a psychiatrist monitor and prescribe these for patients needing them.

[DePressMe]

I believe my psychiatrist to be my strongest advocate...he does support the biological theory, but he also considers therapy and other alternatives to be important aspects of my recovery. Such as he is a qualified acupuncturist and he communicates with my therapist about my care. But, as with any profession, some are better than others.

The good empowering thoughts I have about my mental illnesses being at least partially biological is not to get the drugs I want, but rather to get the drugs I need to help myself get well.

Though it is complicated by neuropsychologists also specialising in the physical causes of mental illness (clinical cognitive neuropsychology, in particular). Cognitive and social psychologists would also maintain that cognition and society are physical causes...

Cognitive psychologists also talk about unconscious processes. For example, we don't have access to the (arguably mental) processes that allow us to transform present tense verbs into past tense verbs. We don't have access to early visual processes either (such as the contents of line and edge and motion detectors).

Clinically, cognitive psychologists talk about 'deep activation' or 'schema / schemata' or 'modular' processes - whose workings are inaccessible to conscious experience and whose operation is fast, automatic, informationally encapsulated etc.

I found an interesting article from a psychiatrist and philosopher of mind working in Adelaide about how (despite what some psychiatrists / psychoanalysts claim) the cognitive psychological unconscious has NOT vindicated the dynamic (Freudian) unconscious. They may have been looking in the wrong place, though (e.g., looking at language and perceptual processing) rather than looking at the work that has been done on clinical contexts / social psychological contexts on categorization and schemata and the role of pairing neutral stimuli with punishers for emotional responses etc etc...