Has anyone else had this experience: You have to change doctors, maybe because you moved, or your doctor retired, or your insurance plan changed. And the new doctor says:
“No, that’s not the correct diagnosis. What’s really going on here is ____ (fill in the blank). And the meds you’re taking aren’t going to do a lot for that. The best way to treat your condition is ______ (list different medications with new effects and side effects).”
Cardiologists Respect Their Colleagues …
Imagine for a minute changing cardiologists and the new doctor tells you that your previous doctor was incorrect. You don’t actually have high blood pressure and high cholesterol but instead the beginnings of diabetes.
What if a new hearing specialist told you that you didn’t have tinnitus; you were hallucinating the happy memory of summer cicadas from childhood vacations.
You’d write them off as crackpots at the very least, more likely incompetents, and perhaps take the time to put a bad review on line, right?
Psychiatrists Act Like Bad Patients
But every time we see a new psychiatrist, they seem to need to override the diagnosis and treatment that previous practices initiated:
“I understand your previous doctor allowed antidepressants on an as-needed basis but that’s not a wise way to control depression. You need to be on a continuous course.” (Result: First and only full-blown mania. The “previous doctor” — head of a nationally renowned medical school’s psychiatry residency — was no dummy.)
“I’m going to record Type 2 on the insurance form but you’re really a Type 1. It doesn’t matter if the mania was induced by medications. If there’s been a full mania, you’re Type 1.” (Result: Change of physician. There’s actually a term for when a patient attempts to control a therapist by bringing up a major subject in the last minutes of the session. There may not be a word for when a doctor does it, but that doesn’t mean it should be tolerated.)
“Bipolar? A lot of women are misdiagnosed as bipolar when they really have attention-deficit disorder. Read this book before the next appointment.” (Result: Oh come on. Seriously? I skim the book quickly. I don’t have ADD. Please. Follow the same treatment regimen your retired colleague did.)
[During a breakout at a conference] “If I were your doctor, I’d take you off half those medications immediately.” (Result: Serious loss of credibility. You’ve just told us that you take a cocktail almost exactly as complex as mine — and still ended up in the hospital because of mismanaging it.)
Maybe the profession just attracts an unusually large number of controlling, narcissistic personalities. It does sometimes seem that every psychiatrist on the planet thinks every other psychiatrist on the planet is incompetent. If so, what does that say about their profession, its standards, and what it is doing to all of us?
Don’t get me wrong. I’m not advocating dumping your pills down the toilet. For starters, there’s already enough pharmaceuticals in the water supply to be damaging wildlife. (Walker Percy may have been delusional at times, but he was apparently prescient on this topic). Still, it does give pause. If psychiatrists don’t believe each other, why should we believe them?
A few years back, when people in DC started to talk about scrapping the whole DSM and starting over, awarding research to projects based on how specific parts of the brain function and misfunction, my initial response was: Another crock designed to rejigger the system of care, without improving the help anyone gets!
Then I ran across a book that is much better than you might expect, given its cover design and its author’s all-too-Sunday-morning-happy name: “Change Your Brain, Change Your Life” by (truly not kidding here) Daniel Amen.
Amen’s clinic has amassed the nation’s largest collection of scans of living brains, more than 87,000, taken during the last two decades in the course of developing a solid understanding of which parts of the brain affect what behaviors. And it turns out that [in my opinion, which I’ve told you before is usually not so humble] he’s got something going for him that the DSM doesn’t. The problem is that the DSM gives diagnostic names to clusters of symptoms that probably don’t have anything to do with each other. So, for instance, the slippery slope people are finding between schizophrenia and bipolar? Maybe it’s because the labels are mixing symptoms without any particular reason except diagnostic tradition. Certain parts of the brain regulate
- emotional volatility (bipolar-type symptoms),
- the ability to accurately process incoming information (including information coming from the brain’s own processes, schizophrenia-like symptoms), and
- the fundamental emotional “tone” (high or low) of a person’s life (affective disorders, broadly speaking).
When more than one of these systems is malfunctioning at different levels, you see what gets diagnosed as (using broad terms, not DSM codes):
- Bipolar disorder with psychotic features
- Schizoaffective disorder
- Depression with psychotic features
In Amen’s approach, you treat the symptoms of each brain system on its own. There are “limbic system disorders” and “cingulate disorders” and “temporal lobe disorders,” some of which may combine in one person. But there’s no need to postulate a “complex multivariate disorder” like schizophrenia.
What Amen has been doing is prescribing a mix of behavioral practices, nutritional changes, environmental enhancements including specific kinds of music (!), skills development, and — sure — medications. But they all target specific parts of the brain and are often quite successful.
Much to my surprise (not so humble me speaking again), this diligent researcher with the ugly bookcover and name like a platitude makes loads of sense.
Say Amen, someone.