First of all, eww. Second, it's always **the craziest** right-wing, gun obsessed assholes proposing this kind of shit with zero self awareness of their own mental illness. : politicalmemes

[–] andros_rex@lemmy.world 34 points 1 week ago (2 children)

I really hope in a few decades people will realize that the warning signs were fucking BLARING with the mental health care system in the US. The carceral approach to mental health care is evil. It is shockingly easy to reach out for help, falling for the 988 ad campaign, and end up in hell. The approach to mental health care is punishment-based, not treatment based. Not about helping anyone, just torturing and drugging into compliance. It’s about giving sadists and underpaid, undertrained “behavioral techs” free access to a vulnerable population. No one advocates for the mentally ill, and many of them can’t advocate for themselves.

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[–] MelodiousFunk@slrpnk.net 13 points 1 week ago (1 children)

$11,000 in debt

That was a lot of action for a one-night stay.

[–] andros_rex@lemmy.world 31 points 1 week ago (2 children)

When I was stupid enough to reach out for help last year, they joked about how the legal three day hold only counted for business days, so they could hold me for a full week. They really do not like doing one day stays.

They threw away my grievance forms - I was physically assaulted by staff, had vape smoke blown in my face. I ended up losing my job because I disappeared without being able to communicate and they didn’t give me work release forms.

It was really my final straw with the entire system. My mother used troubled teen facilities and hospitals when I was a child to punish me for speaking up about her alcoholism and sexual abuse - I’ve never seen the system work.

[–] fluffykittycat@slrpnk.net 7 points 1 week ago

Oh my god that's awful

[–] RubberElectrons@lemmy.world 6 points 1 week ago

Sorry you experienced that. I hope there's something to eventually counter all that you've dealt with.

Universe doesn't care, but we do.

[–] TheJesusaurus@sh.itjust.works 18 points 1 week ago (3 children)

"paternalism"

I'm a father myself and if my kid was out on the street, you can bet your ass I would be too, because as long as I have a roof, so do they.

How did paternalism come to mean patronizing those who are less capable and treating them like subhuman chattel, instead of treating them like someone we love in our care?

[–] nova_ad_vitum@lemmy.ca 7 points 1 week ago

They just want to criminalize homelessness and throw them in jail. That's it. That's all this is.

[–] YoSoySnekBoi@kbin.earth 7 points 1 week ago

I think largely it stems from the targeted infantilization of disabled people throughout most of Western history. Adults who are stripped of rights and treated like children for the convenience of a society that doesn't feel like helping them (see: institutions) tend to start seeing parental roles in their life as sinister, because they tend to make decisions on their behalf and remove any personal agency they may otherwise be afforded.

Combine this with fundraising efforts that once again, treat disabled people as pitiable, helpless, and childlike, all to raise money that never actually goes towards helping them (see: telethon), and you have a system ripe to force people who want an actual life to push away offered help and become radically independent.

That, and unfortunately, an attitude like yours is relatively uncommon. Being patronized and dehumanized by their parents seems to be a much more familiar experience to most than being loved by them.

[–] ohulancutash@feddit.uk 1 points 1 week ago

It was a critique of the idea that the Great Men were doing the childlike savage an immense service by taking over their lands and setting up the complicated systems of bureaucracy and industry that they were too infantile to grasp. And, of course, when any child speaks out of turn or acts out, they must be punished.

[–] xxce2AAb@feddit.dk 17 points 1 week ago

Yeah, "disrupting bipartisan orthodoxies", like "a country should have a functioning economy", "nepotism is bad" or "crime should be punished".

[–] TheJesusaurus@sh.itjust.works 16 points 1 week ago

You can just remove the word mental there.

It must be said that the USA DOES NOT have a healthcare system, as that implies some kind of structure, regulation, standards, etc.

The USA has a complex overlapping patchwork of insurers, whos goal is to maximize profits.

What we call patients in the civilized world are just paycheques in America. The only system that exists is one to squeeze every drop of blood from the stone, and when the stone is utterly broken, squeeze their insurance for more.

That is a system, but it is not healthcare

[–] AcidiclyBasicGlitch@sh.itjust.works 14 points 1 week ago* (last edited 1 week ago) (1 children)

"I can't be crazy because I've never been to therapy!"

"I just keep all my shit stuffed so deep down it eventually seeps from every pore. Punishing strangers via harmful policy I unleash on society gives me a sense of calm and control. Namaste." 🧘🏼‍♂️

Trump signs an executive order to make it easier to remove homeless people from streets

A Look at the New Executive Order and the Intersection of Homelessness and Mental Illness

[–] jordanlund@lemmy.world 1 points 1 week ago* (last edited 1 week ago) (3 children)

Well, what do you do for people like this?

60 years old, homeless for 10 years, living unsheltered on the side of a major freeway, leg infected to such a degree she had to have a foot amputated, leg then re-infected, other people keep stealing her wheelchair, but she refuses services, sitting in the dirt, feet away from 55mph (88.5kph) traffic, in 101° (38°C) heat.

https://katu.com/news/homeless-crisis/woman-struggling-to-survive-along-i-5-in-portland-a-firsthand-look-at-finding-help-with-homelessness

"Vicky is known to our outreach workers, as well as teams who work with the city, all of whom have been attempting to provide services or engage for several weeks. At times, she has informed those teams that she has not been interested in care. But they continue to check in and try to work with her."

Universal Health Care means Universal Mental Health Care too, and until we can get people off the street and into care for their own well being, we will continue to see situations like this.

At what point do you tell someone "you're incapable of caring for yourself, we'll do it for you."?

[–] ArsonButCute@lemmy.dbzer0.com 10 points 1 week ago (2 children)

Never, you can bring a horse to water but you can't make it drink. You can give a person help but its up to them to take it. Even humanitarianism requires consent.

[–] jordanlund@lemmy.world 3 points 1 week ago* (last edited 1 week ago) (2 children)

Leaving someone to die at the side of the road is not humanitarian.

[–] CentipedeFarrier@piefed.social 14 points 1 week ago (1 children)

Forcing someone to undergo potentially mind-altering medical treatment (because they absolutely will drug someone who fights against being there) and probably abuse (just check the stats) at the hands of the system isn’t humanitarian either.

This is one of those situations where all you can really do is make sure the options are as good as they can be, so people want to choose to get help, and we are not even remotely doing that.

[–] jordanlund@lemmy.world -5 points 1 week ago (1 children)

Severely mentally ill people don't want to choose help, that's a function of being severely mentally ill. Leaving the decision making to people fundamentally incapable of making a decision actively harms them.

[–] CentipedeFarrier@piefed.social 11 points 1 week ago* (last edited 1 week ago) (1 children)

If the system was actually helpful to people, and severely ill patients still didn’t want help, you might have a point. Right now though, the system doesn’t help most people, it harms them actively, so we don’t actually know how many people would still refuse quality care.

And let’s be serious here, the number of people so mentally ill they can’t be trusted to make a decision about whether or not to take offered help..? Really really small percentage. We definitely shouldn’t be structuring the entire system based on edge cases, even if those edge cases have a legitimate need for that sort of inhumane treatment (a premise I strongly question).

[–] jordanlund@lemmy.world 1 points 1 week ago (1 children)

That's an argument to fix the system, which I 110% agree with. That doesn't mean we shouldn't get people the help they need.

[–] CentipedeFarrier@piefed.social 4 points 1 week ago (1 children)

Yes, however it’s mostly a refutation to your prior comment that severely mentally ill people refuse treatment as a direct consequence of being mentally ill. This is only rarely the case. The vast majority of those severely mentally ill people are still people capable of learning about stuff and doing cost-benefit analysis for their own lives. They make rational decisions to the best of their ability. This ability may be flawed, but that’s the case for all people. Nobody has a pure, 100% complete and accurate view of things.

They refuse treatment largely because the system is horrible. Would they still refuse if the system wasn’t horrible? Most of them probably would not, because struggling is really hard. Most of them would get themselves the help they feel they need if they honestly thought there would be a good outcome.

But what they think they need and what the system or society thinks they need aren’t necessarily the same thing. Maybe all they really -need- is a place to exist exactly as they are, with zero medical intervention, with a clean environment where they feel safe and secure. If that’s all you felt you needed, would you risk being drugged for the rest of your life? I sure as hell wouldn’t, no matter how bad my experience of existence is. At least I have agency.

And honestly until we reach that point, where mental healthcare is supportive to the individual and genuinely helps them live whatever they feel is a fulfilling life, discussing what to do with the minuscule remaining fraction of sufferers (a number we genuinely can’t even quantify at this point) is sort of dumb, and seems like a pretty big distraction from doing anything better for everyone who isn’t in that camp.

[–] jordanlund@lemmy.world 0 points 1 week ago* (last edited 1 week ago) (1 children)

They percieve the system as being horrible, but again, that's a function of their mental illness.

The system does have problems, but there's no refuting the fact that whatever problems the system has, it's infinitely better than an amputee with an infected leg sitting in the dirt with no shelter.

[–] CentipedeFarrier@piefed.social 5 points 1 week ago

I do refute that “fact”, though.

I personally would rather be an amputee on the side of the road with no shelter than be kept prisoner in my own body with the use of drugs and restraints. That’s literally my worst nightmare. And I’m not “severely mentally ill”.

You don’t know what reasons she has for doing what she does, but what IS completely, abundantly, crystal clear, is that she herself considers the position she is presently in to be better than whatever she would potentially deal with under care. And you don’t know why she came to this conclusion. Maybe she was institutionalized when she was young and was abused or whatever and has ptsd about it. Maybe she knows someone else who was.

Or yeah, maybe she’s so mentally ill that it’s forcing her to deny care. I strongly doubt it, but maybe. And we’ll never know unless we fix everything else first. So. Kinda moot point, isn’t it?

[–] ArsonButCute@lemmy.dbzer0.com 8 points 1 week ago (1 children)

Neither is forcing them to accept care they don't want.

[–] jordanlund@lemmy.world 1 points 1 week ago (1 children)

That's still better than letting an amputee sit in the dirt, feet away from freeway traffic, unprotected in 100° heat.

At some point there needs to be a competency hearing and the person cared for even if they can't or won't ask for it. ESPECIALLY if they can't or won't ask for it.

The alternative is going "Welp, too bad they died, nothing we could do."

[–] ArsonButCute@lemmy.dbzer0.com 10 points 1 week ago (1 children)

This is something you and I aren't going to agree on. From my perspective its an issue of consent. From yours (it seems) and issue of wellbeing. Our heirarchies of needs seem to value personal agency at different levels. I consider it to be a core need, and from that perspective I would never (given the power to do so) exert my will to care for someone as a ward of the state or whatever org I represent without the consent of the individual to be cared for.

I also recognize what you're saying, that at a certain level of incompetence a person should no longer be able to advocate for themselves and should be required to accept care.

I personally believe that if a person can communicate, they can communicate consent. If a person is completely unable to communicate, it may be a good idea to give them a period of investigative and protective custody to determine their safety, but from their perspective that could be a kidnapping.

I'm not saying your perspective is wrong, but this is a situation that needs to be handled with extreme nuance and care by professionals.

On competency evaluations:

I'd need a large panel of Psyches from the same and similar communit(y/ies) as the JD (john doe/ jane doe) to all agree they are incompetent before I'd be comfortable allowing their consent to be violated in the manner of state endorsed internment in medical or mental facilities. If the medical community agrees, and the people around the JD agree, then and only then should the JD be given care without their consent.

[–] jordanlund@lemmy.world -1 points 1 week ago (1 children)

I think the difference in our opinions are less than you think it is, you argue from a point of personal autonomy, and I get that, my argument is they have already lost their autonomy due to mental illness.

So if they have no autonomy already, society needs to error on the side of making sure they get appropriate care, especially when the alternative is utter destitution and death.

[–] captainlezbian@lemmy.world 2 points 1 week ago (1 children)

I think that's an incredibly risky philosophical position to take that should be examined in conjunction with discussing it with people of varying mental illnesses and recovery statuses.

Especially when we discuss the sane choosing for the insane we run the risk of unknown cruelty. Mentally well people have a long history of assuming they know what's best for the unwell and in doing so accidentally doing something harmful. Things like criticizing the bodies of anorexic people, shaming those struggling with executive function, blunt refutation of delusion, basically whatever Phil McGraw does on his show.

So is it anyone with a mental illness that refuses treatment that can be institutionalized? Only certain disorders/symptoms? Only certain severities? Will we know it when we see it or will we accept that some people who seem like they should be won't be or vice versa? Are we comfortable with the risks of abuse of power here? What about the weight of bias from the part of the mental health professionals assuming anyone in front of them must be unwell? In diagnosis there is no madman's advocate, even when the cost of diagnosis is difficult to distinguish from imprisonment.

[–] jordanlund@lemmy.world 3 points 1 week ago (1 children)

That's the whole point, if the insane had the capacity to choose for themselves, they wouldn't be insane. 😉

I argue that if personal autonomy leads to being homeless on the side of the freeway and, ultimately a miserable existence and death, society has an obligation to step in.

At some point, someone needs to recognize that that level of autonomy is going to cause a preventable death.

[–] captainlezbian@lemmy.world 1 points 1 week ago (1 children)

I believe society also has an obligation to step in, but with an open hand and possibly some incentives, not with a display of force. And yes, involuntarily institutionalizing someone is a display of force.

And my questions remain: define insanity as it is something you are willing to deny self determination to someone over and decide where the limits are in each direction. And the fact that you didn't acknowledge the study I linked to the Wikipedia page for says a lot. The Rosenhan Experiment is a large part of why we drastically cut down on forced institutionalizations in the US, because psychiatrists were not getting the consistency in diagnosis to justify what they were doing.

Insanity isn't a single thing, its a values based severity and pattern judgement of mental behavior that people make. A person with delusions is one of the archetypal "insane" people and yet some of them can hold a job and seem fine until the topic of aliens comes up. A person with executive function disorders may struggle to hold down a job while being fully aware and desiring to do so, but the idea of a padded cell may be so horrifying to them that they'd rather risk dying outside to it (and yet these disorders are quite common in significantly milder forms). Hallucinations are extremely stigmatized, but also in their mildest form they're just normal (hearing your name in random noises for example). A person who chooses to live in a van traveling and performing for little money even when they have far more successful opportunities may be called insane by some, and I'm strongly suspicious that the ratio is dependent on their performance skills.

That's before it gets political. To a person in China, Patrick Henry might be declared insane for asserting that if he cannot be given liberty then he should be given death. There are sitting congresspeople who want to institutionalize critics of the president and trans people. If you grant the power to institutionalize people without strict limits and controls you create a weapon of repression.

A person who speaks out against the party in a totalitarian regime may lose their job and home, and in such a case insanity and integrity may become identical. Hell someone in the 1970s insisting that the government is attempting to mind control people by dosing them with LSD and is infiltrating left wing organizations to disrupt them. At the time that was insane conspiracy theorism, today that's American history thanks to the reveal of MK ULTRA and COINTELPRO. A hundred and fifty years ago you could be institutionalized for shit that horrifies people today.

The fact is, I'm comfortable with risking that some people die if it means everyone has more freedom from excesses in government force. I already accepted it with criminal justice as a part of my opposition to the absurd sentences America has and our fear of recidivism. I don't want that person you talked about to suffer, I'd much rather that she get help. But when you give the government or medical institutions the power to lock up those they deem irrational and incapable of making their own choices you give them the power to strip freedoms from those they choose.

There's a lot of writing on this, much of it is from those with a history of mental illness. I highly recommend reading some to better argue against it.

[–] jordanlund@lemmy.world 2 points 1 week ago* (last edited 1 week ago)

The inherent problem with the Rosenham Experiment is that it involved sane people actively attempting to deceive doctors. That has no bearing on a sane person being incorrectly diagnosed assuming they do not attempt to appear to be insane.

In fact, that entire experiment is more or less discounted as fraud these days:

https://www.sciencehistory.org/stories/distillations-pod/the-fraud-that-transformed-psychiatry/

Mental health professionals, in fact, take the 'mental' part out, health professionals in general assume that people presenting a medical condition are honest brokers*, they can't be faulted for failing to detect unreliable narrators.

* With the notable exception of women and minorities. Doctors seem all too willing to discount self reporting by women and minorities, that's an entirely separate issue.

https://www.health.harvard.edu/pain/the-dangerous-dismissal-of-womens-pain

https://www.hopkinsmedicine.org/news/articles/2021/06/physicians-more-likely-to-doubt-black-patients

But to get back to your larger point of how do you define mental illness severe enough to when society needs to step in and take over:

It should be super simple. When your mental illness reaches a point where it's having a systemic impact on others.

The lady sleeping on the freeway is actively posing a danger to other people. If some motorist hits her, she's not the only person who is going to be critically injured. She needs to be removed and treated.

Or, take animal hoarders for example, they are actively posing a danger to the innocent animals they have collected.

It's the whole "your right to swing your fist ends at the tip of my nose." Someone quietly going insane, not bothering anyone and refusing treatment is far different than, say, someone wandering into traffic waving a sword around.

Man, I WISH I was kidding about that last one.

https://www.oregonlive.com/portland/2015/05/sword-wielding_bipolar_man_in.html

When your problem becomes someone elses problem, it becomes all of ours problem. That's when someone steps in. I'd much rather have it be a psych ward than the cops.

[–] obsoleteacct@lemmy.zip 1 points 1 week ago

It would be ideal if everyone could take a step back and appreciate that it's society against the problem of mental health, not the well vs the unwell.

But civility and humanitarianism are frail. They don't hold up well against humiliation, disgust, or fear. Eventually the general public will opt for an inhuman solution over no solution at all.

[–] AcidiclyBasicGlitch@sh.itjust.works 2 points 1 week ago* (last edited 1 week ago) (1 children)

I agree with you it is a major dilemma when you have a situation where someone is stuck in a pattern that is essentially self harm and a cry for help, but they refuse help. I've actually been dealing with an ongoing similar situation for an immediate family member.

I'm the last one that they have contact with. I've spent my life begging them to get help. I say this not as a judgment for any other person's situation, but in my case it felt like starting from a very young age, I spent most of my life trying to save somebody who was supposed to be the adult in the situation, but emotionally they were an angry child lashing out at every one who activated them. It didn't matter what I did or how hard I tried, I just never could help them or convince them to get help.

It took me going to therapy to even realize that it didn't matter how many times I kept throwing a life preserver, they were just going to keep batting it away. That was part of their mental health issue and the continuous cycle. In my case they preferred to just have someone drown with them because they were too scared to get help/hear the truth I guess.

Anyway, it got to the point it became detrimental to my own physical and mental health. I still do what I can, but I basically had to just accept that I'm an adult now with my own life and other responsibilities, and I couldn't keep doing this to myself or my family for somebody who I was essentially enabling by dropping everything and rushing to their rescue over and over.

It absolutely breaks my heart to think about it, but the honest answer is, it's a shitty situation and there isn't a good answer at the moment. However, if there is a solution, it's not going to be a cheap or easy one.

Even in the case of my family member, I feel safer with them taking the risk of being on the streets than I would if they were locked away in institution that has an incentive to keep people mentally ill forever with no oversight for human rights, and no standard of care.

I talked to a case worker not that long ago who said she had a patient who had been in a full blown state of psychosis for months with no help. I know how frighteningly fucked the medical system (which was never great to begin with) is in this country right now. There is no help or even getting better for most health issues. Mental health was always at the bottom of a broken healthcare totem pole even before Trump 2.0.

It's just another continuous cycle where conservatives yanked funding and fired everyone or got them to quit from rather than keep banging their heads against a wall trying to help people with resources that no longer exist.

Now people are just shuffled from place to place with no chance of actually getting anything resembling help until they're sent to the ER for an actual life and death emergency. If they survive, they're just released back on to the streets. It's a very expensive and worthless cycle, and the people that caused it love to claim it's evidence that Medicaid is unsustainable. Soon they'll probably be claiming it's also evidence it would just be cheaper and better for everyone if they could just lock people up and throw away the key.

That's what's so absolutely fucked about all this. It's not that they want people off the street because they want to help them. They're making it easier to just lock people away for life, while simultaneously making more cuts for mental health, substance abuse, and housing assistance than ever before.

It's their same approach to solving crime. It's not a solution to just lock all poor people up so that there aren't any more people desperate enough to commit crime. It doesn't solve any of the complex social issues that are driving crime, addiction, or mental health problems, and often the people making these policies have an added incentive due to their own investments in the entire fucked up system they've created.

The more you jam pack private prisons/detention centers/institutions, the more their stock goes up. And it's so fucking sneaky and evil how many fucking different ways they've figured out how to capitalize on the problem and prey on people who need help instead of actually just trying to help them.

It's not even just private prisons anymore. Now it's also the fucking transportation companies to and from the prisons. It's the pharmaceutical companies that manufacture the expensive patented medications that doctors are pressured to prescribe to patients when they're institutionalized.

I literally wouldn't be surprised to learn that there are oligarchs hedging their bets on Trump's executive order to make it easier to lock people up for mental illness. They're probably buying up stock in hospital beds and whatever company makes straps to keep people restrained.

They think that there's nothing wrong with this. That they're just being smart/good at business by backing the policy that's destroying lives, and that they're actually "helping people" by taking them somewhere else where society doesn't have to see them or think about them. Out of sight. Out of mind.

I think that the day we start locking up these callous, wealth hoarding, manipulative, narcissistic, predatory psychopaths away from the rest of society and forcing them to get treatment, maybe we can start talking about locking up everyone else against their will for obvious mental health problems they refuse to address.

That's what it really is. The same old saying that a poor person with mental illness is a burden to society while a rich person with mental illness can be an eccentric. Except the eccentrics have been allowed to take over the government, and they've started capitalizing on their ability to do harm to others. The "eccentrics" who claim that their callous and unemotional behavior is what makes them so great at the game of life, even as they continue to pose the most obvious threat to society compared to the "crazy people" they want to lock away.

[–] jordanlund@lemmy.world 2 points 1 week ago

All true, and incentive to fix what's wrong with the system, but we can't fix it in it's current state, it needs billions in investment to reverse the damage caused by Reagan that turned people loose in the streets in the first place.

Locally, in my town? I think a billion would cover it.

We need a no questions asked hospital for medical care and a no questions asked mental health/addiction clinic. Get everyone the treatment they need. If they need permanent care, provide permanent care.

If folks are physically and mentally fit (or when they become physically and mentally fit), they need an agency for job training and placement and housing assistance. Provide email, address and phone service, as well as laundry assistance. Job and interview training.

There also need to be specialists on the job and housing sides too who deal with people with criminal records.

Speaking of, people with open warrants or actively committing crimes need to go through the criminal justice system.

[–] Brkdncr@lemmy.world -1 points 1 week ago (1 children)

You have them evaluated and tell them to either get help or prepare to receive help.

Wanting to live off-grid is one thing but choosing to live on the sidewalk in front of my house is not acceptable.

[–] jordanlund@lemmy.world -1 points 1 week ago

Yup!

[–] daannii@lemmy.world 8 points 1 week ago* (last edited 1 week ago) (1 children)

So I'm a research psychologist.
We often butt heads a bit with the clinicians (therapist, counselors). Because. A hell of a lot of them do not follow scientific evidence -based methods or treatments. A lot of them don't even seem to know or understand basic human psychology. It's honestly scary to talk to them sometimes.

Specifically the designation PsyD is a degree which requires zero research experience. This degree also is a "pay to win" degree.

Meaning you basically pay to attend the program and you get the degree. This is much different than a PhD where you compete for a graduate position and the university pays you to attend. A PhD requires not only 5-6 years of research but a thesis and dissertation that is reviews by a committee.

These positions are very competitive, as you can imagine.

A lot of people who want to be clinical psychologists (the most competitive area in PhD programs) will instead do a PsyD. Many PsyD programs have very low competition or none. They want your money.

Now I need to clarify something. A PhD psychologist doesn't guarantee high quality evidence -based therapists. And some PsyD programs are evidence based.

But. Mostly. PsyD are lower quality and PhD therapist are higher quality. Someone who does not learn how to do research or understand the statistics, can't then read research papers and understand them or critically evaluate them. Kind of important, wouldn't you say ?

There is research on this showing poorer outcomes from PsyD and that they use less evidence based practices.

And lastly we have psychiatrists. Psychiatrist are MDs. Medical doctors. They don't go to grad school. They are trained only in diagnosing and pharmaceuticals. Because they are medical doctors. They approach mental problems as if they are purely biological (for the most part).

That's why only psychiatrists can prescribe drugs. Not PsyD, or PhD therapists.

Now I am not clinical. But. I believe strongly, that mental healthcare workers (at any level) should be held to the same standards as medical professionals.

They should not be allowed to use non evidence based therapies. They should not be allowed to create their own definition of a mental disorder. They should be required to follow specific guidelines of approved approaches. Diagnostic and treatments. And if they don't, they should be sued for malpractice and potentially lose their license.

Because these individuals destroy peoples lives. They do a lot of harm. And they erode the trust in mental health care.

Many do pseudoscience b.s therapies. And charge money for them.

That should be illegal.

We don't have enough regulations on mental health care. And it's a bigger problem than people realize.

[–] AcidiclyBasicGlitch@sh.itjust.works 3 points 1 week ago* (last edited 1 week ago) (1 children)

Yeah I've known a lot of these people as well.

In some states PsyDs are allowed to prescribe (but there might be limits on what they can prescribe vs a psychiatrist).

We don’t have enough regulations on mental health care. And it’s a bigger problem than people realize.

I agree 100% on there being a need to focus on evidence based practice, but I also don't think that it necessarily as clear cut as a more rigorous degree = somebody will make a good therapist. A problem of not listening to/believing your patients is also a major issue in just about any healthcare setting (including mental health).

Example: I have ADHD and see a psychiatrist for that reason, but I learned pretty quickly a psychiatrist does not want to hear about your problems. (I think some old school psychiatrists are slightly better about this. Not old, old school, but there seems to be a divide between ones who did their residency in the 90s vs 00s and beyond in my state). Anyway, psychiatry also requires a more rigorous degree and a very long somewhat grueling and competitive residency, but it can be a pretty cushy job once you get established.

Most psychiatrists want to figure out what you need, prescribe it, and then just check in every few months to see if you need a dose adjustment. They (like most doctors unfortunately) don't like to hear things that contradict what they already believe.

I saw mainly residents in the beginning when I finally started trying to address my lifelong ADHD problems in my 30s. Most immediately assumed I was just drug seeking, and kept treating me for depression instead of just believing me when I tried to explain myself. I ended up taking Wellbutrin for several years alongside my ADHD meds even though it had only been prescribed to me in the beginning bc the psychiatrist didn't really think I had ADHD.

I wanted to stop taking it but nobody would just listen to me or believe me. Eventually I had to wean my dose down myself (do not take this as a recommendation to try, especially if you take any extended release medication) and just stop taking it altogether to convince my psychiatrist that I hadn't needed anything other than the ADHD treatment in the first place.

Especially when it comes to getting psychiatrists to understand that people respond differently to different medications (especially extended release and generic meds) or combinations of medications, there are many psychiatrists who will just straight up refuse to believe their patients because "that shouldn't be the case."

I actually worked in a molecular bio lab for a while. The PI was a very rigorous scientist (in her own way) and had done some pretty incredible work in her area of research. However, she was also one of the most stubborn and hard headed individuals I've ever known, and it was exhausting. I remember her randomly going off once about stupid uneducated people not understanding there's no difference between a generic drug and a name brand drug other than price.

Except we know that there are many factors that can actually change the way an individual body processes and metabolizes medication, including hormones and gene polymorphisms. We know that some companies use different fillers and binding ingredients in their recipe, and there's also been cases where generic drug manufacturers have been shut down for poor quality control.

If you have patients noticing their medication suddenly isn't helping, and then seeking answers, and you have scientists and medical doctors both rushing to the same conclusion and dog piling on this somewhat outdated belief about generic drugs, you end up with people being gaslit and told they're just being difficult/making things up. Think about all the times people tried to tell their doctor their medication wasn't working, and were dismissed because "that shouldn't be the case."

That's a pretty dangerous attitude to have in science and medicine. Science isn't supposed to be a religion. You're supposed to be skeptical and question things. In medicine you're supposed to treat the patient, not the disease. Yet there are people in science and medicine who become so rigid in their beliefs, biases, and established ways of thinking that they essentially make it their unquestionable religion. God help you if you challenge their beliefs regardless of what evidence you may have to present your case. It's toxic and it ends up placing the ego of the doctor or scientist above the well being of the patient or research.

I think like most things, it's a pendulum that shouldn't be swinging too far one way or the other. There are plenty of quacks out there who use woo woo to grift and destroy people's lives, but there are also a scary number of highly educated and trained doctors who refuse to treat the patient not just the symptoms. They're both dangerous in their own ways and they both erode trust.

I ended up also seeing a PsyD just to get an official evaluation and diagnosis, because most accommodation arrangements require a behavioral assessment, not just the diagnosis from a psychiatrist. I definitely think the standard evaluation process could use some tweaking and updating from psychologists with a research background, but I can also see why you would want a behavioral assessment from a clinician in addition to a psychiatrist diagnosis.

As far as therapists go, surprisingly, I've found social workers who obtained a license for clinical therapy to be the most helpful and willing to really listen to the individual. I've also found help in some nontraditional and unexpected areas that were recommended by my therapist like somatic breathing and stretching. Obviously it's not a guarantee this is what each person will benefit from, but again, it just kind of seems like a pendulum situation/don't throw the baby out with the bathwater.

I think ideally, a team of professionals working together and in some basic level of communication with each other to coordinate care, would result in the best outcome for patients. But the more administrative health policy relied on efficiency as the ultimate goal of measure of determining best practices, the further the pendulum swings away from that ideal.

[–] daannii@lemmy.world 2 points 1 week ago (1 children)

Well a psychiatrist is a medical doctor. They aren't really trained to counsel you. Except on medications. If you want someone to talk to, you need to see a psychologist. Or masters of social work (counselor). Like psyD. It's hit or miss with them. It heavily depends on the quality of their education institution.

I think also many people dont know the difference between psychologist and psychiatrist. They often go to the wrong one for their issues. Most people would benefit from going to both. Not an opinion. There is research supporting that.

It's not uncommon for them to work together for a specific patient.

Psychiatry is not more rigorous. Infact I would argue it requires the least psychology education out of the 3 I mention.

A psychiatrist first goes to med school. Then completes additional residency and training in psychiatry. Which again, is primarily focused on administering tests/batteries and prescribing medications.
And learning how to adjust meds. Which meds should be tried first. Which side effects are normal and which indicates a problem. They have no training on giving talk therapy.
Their only therapy is medications. Some offer talk therapy. Which is a problem because it's just their own personal biased beliefs about what talk therapy should be.

And it's true that in some states there are exceptions for PhD to prescribe some mental health drugs. It's not very common. It's only a handful of states and there are a bunch of steps to be able to do that.

People like me, who are researchers know a lot about the mind. Cognitive. Memory. Sensory. We know the limits of introspection. We know about cognitive dissonance. We know that culture heavily influence a given experience.

It's this base knowledge that so many PsyD people lack. Many didn't even have a bachelor's in psychology.

And even if they did. They werent able to get into a PhD clinical program because they were not considered good enough. They didn't have the right experience , grades, or any number of other qualifications. Another gate to PhD programs is you have to learn math statistics and do research. And many people want to be a therapist but don't want to learn the math or do challenging research.

I know that sounds mean to say but it's true. And when you don't develop those skills, you don't learn how to critically analyze research.

You can't tell good science from bad science.

You can't tell the difference between effect size because you don't even know what that is or how it's computed.

This is the bigger problem. What you end up with is therapist who use their own flawed intuition and personal theories (as well intentioned as it may be) to make decisions on mental health care for others.

If they had actual training in cognitive psychology, they would know that humans are incredibly biased and we cannot use our own judgement but must, above all else, rely on the scientific method. Everything must be tested.

We are wrong about so much because of how our brains work. (Confirmation bias being the big one). We are incredibly limited in our ability to see bias in ourselves. It's actually almost impossible.

A good therapist should understand that they are by their human nature, biased.

And that they need to trust scientific evidence based practices.

And they need to be able to evaluate that evidence and update their knowledge as new research and theories are developed.

Ive met psyD people who were taught by research oriented professors. Who learned stats. Learned to evaluate research. But it's rare. Most psyD programs do not teach clinicians any of that.

Ive also met PhDs who did half assed research and their professors did not promote scientific based methods. The kind of research that never gets published because it's so poor quality.

But typically it's psyD programs that produce the lower quality therapist and phD produce the best. As I said, this isn't a personal opinion. There is research on this topic.

This is why as a prospective student, you have to do a lot of research into the institution you are interested in.

So many psyD institutions are closed all the time or have fasfa money cancelled because a review of their education curriculum shows they aren't following modern standards.

PsyD people are the ones promoting recovered traumatic memories (not a real phenomena, these are false memories). Promoting split personality (it's not possible for a human to have two person inside them). And a bunch of other nonsense stuff like that. EMDR comes to mind. Which is pseudoscience wrapped around a legitimate therapy.

They make up b.s conditions like "peter pan syndrome" or "daddy issues" and promote them as being scientific mental health issues when they are cultural/society issues.

Dr. Oz an Dr Phil are prime examples of how so many of these PsyD people operate.

They throw around Freud nonsense as if it explains something complex. It doesn't.

Freud is not considered scientific by modern standards. None of his theories have held up with scientific investigation. Same for Jung.

You hear anyone say either of those names, run the opposite direction. It's all made up nonsense.

People are getting charged money for these services from people who are filling their head with nonsense. Making their conditions worse.

Not actually helping them. And charging them money.

[–] AcidiclyBasicGlitch@sh.itjust.works 2 points 1 week ago* (last edited 1 week ago) (1 children)

Well a psychiatrist is a medical doctor. They aren’t really trained to counsel you.

No, but they are trained to diagnose you, and if they're unwilling to actually listen to what their patient is trying to say, then they can't really know what the problem is.

Another gate to PhD programs is you have to learn math statistics and do research. And many people want to be a therapist but don’t want to learn the math or do challenging research.

Most basic scientists: "How do I run an ANOVA in SPSS/Prism?"

I guess we've had different experiences. Not sure if you're doing things like fMRI studies, but the majority of math I've encountered in basic science research has just been plugging data into a program. I suck at math, but I've always kicked ass at research, especially ideas for future directions, experimental design, problem solving, lit review and writing.

I know in my state at least there was at one point a Psy D program that people completed after getting their Psychology PhD. Most of those people were in clinical labs that actually seemed to be super into really advanced stats, and "making the data say whatever they needed it to say." Which, ngl, always seemed like a kinda fucked up way to approach research, but I'm no stats whizz, so who am I to judge.

[–] daannii@lemmy.world 1 points 1 week ago (1 children)

Yeah p-hacking is a huge big problem in psychology.

And it's true. You can use sleazy approaches to get the numbers to give you the results you want. But luckily there are specific guidelines on statistics and if you use them to do p hacking. You won't get your paper published.

The people who review the papers know what p hacking is.

And it's also true we mostly use stat software. But.

Before we use the software. We learn to do it by hand. It's imperative because this is the only way to really learn how to do it properly with software.

People are really intimidated by statistics. And I'm not going to lie and say I found it easy. I didnt.

I had very poor math skills coming in. And I spent at least 20 hours a week outside of class , going over math basics and trying to re educate myself. Because I didn't even have a strong high school level of math proficiency.

But I wanted to do research so bad. I told myself I was going to learn it. And excel at it. And I did. But it was a lot of frustration and tears on the way. And an incredible amount of additional study hours on a topic that put me in a bad mood. I had to bribe myself with so much ice cream to stay focused.

Also ive never heard of anyone with a PhD getting a psyD later. Are you sure about that ? Not saying you are incorrect, just saying Ive never heard of that.

People sometimes do post-docs after PhDs. That's just more research tho.

[–] AcidiclyBasicGlitch@sh.itjust.works 1 points 1 week ago* (last edited 1 week ago)

I'm not a clinical psychologist, I just knew a lot of people who were in a traditional clinical Psych PhD program, and PsyD was one of the path options they could take, if they wanted to become a medical psychologist/prescribe medication. Idk if it was just a short cut so they didn't have to finish the full PhD program, but they had been accepted into a PhD program.

They still had to complete basic course work including stats, which was one of the only class where we overlapped. I don't remember anyone ever doing stats by hand. I do remember the people who were clinical usually didn't have to collect their own data or do any experiments for their M.S., but they also were more likely to use really high level stats analyses. I remember words like bootstrapping, and it seeming very complicated.

At one point I did use a massive data set for a class project to run forecasting or something? But post grad school, a 3-way anova is about as advanced as I've ever needed to get. There are people who do more advanced stat work in basic science, and use R instead of the easier programs, but it's definitely not the norm from my experience. I guess it just depends on the size of the data set you're analyzing and what you're trying to do with it. For example, I was talking to somebody recently who worked in infectious disease, and she mentioned that the highest level stats she ever used was a t-test.

From my own experience (maybe it's just a U.S. thing, idk) but there are people who do very important research without using very complicated stats, and there are people who do very important research and also use very complicated stats. There's also often a collaborative effort where one side may be more involved in generating the data to a certain point, and the other has a very niche role where they take the research relay baton and do their complex voodoo that I don't really understand.

There are also people in public health and other fields who don't always do their own research, but still use giant data sets to answer very important questions. Then there seem to be some people in various fields who never design their own experiments or collect their own data, but recycle huge data sets over and over again for p-hacking using very complicated stats that I don't understand.

I admit my experience is completely dependent on how science is conducted in the U.S., but even an 8 year PhD from a prestigious institution, plus a series of never ending post docs from other prestigious institutions, and the ability to do the most complicated stats, would not make me assume that person is necessarily smart or skilled in anything other than their own niche area of research.

The same is true for an MD or MD/PhD. They might be very smart in whatever residency they completed or whatever field they achieved their PhD, but how do they actually think about new information/approach problem solving?

I feel like we all grow up hearing way too often, that we're all smart in our own unique way, (which is probably true), but most people tend to avoid acknowledging the fact that we're all also very dumb in our own unique way. No single person can know everything, and no human or machine is ever completely free from error.

Empathy, respect and consideration for others, along with critical thinking, and fluid problem solving skills, are usually not things people learn in a classroom or lab. Unfortunately, those skills are also undervalued in society until the moment inevitably comes when they are desperately needed. Then, big surprise, most people don't even know how to begin to think about ways to approach a new problem, because they never really learned to think outside of a rigid and sometimes biased box.

On the rare occasion they actually allow their ego to take a break for a moment, and try to think critically about a complicated problem, the ego will often snap back into place the moment anyone questions the off target consequences or downstream effects of their idea. This is another reason it can really pay off to have an entire team people who are uniquely smart and uniquely dumb in their own way, with varying degrees of education and life experience, all working together to solve a problem.

When you use any level of education as a tool to help you continue to think critically and solve new and challenging problems, that's very helpful for all of society. When you allow your level of education to become your impenetrable ego, and act as a blinder/shield to even consider any information that seems like it might contradict what you already believe to be true, it becomes a danger to society.

[–] But_my_mom_says_im_cool@lemmy.world 3 points 1 week ago (1 children)

Tbf I’ve always had an issue with mentally ill homeless people being held not responsible, but nobody else is held responsible for them when they’re unable. Leaving them to be victims and asp victimize others over and over. The same violent mentally ill people are known by all in the city, they get picked up and get released right away. If they’re not responsible and they are unable to ask for help, when does an authority step in and take responsibility and get them the help they need whether they like it or not. I have a wealthy aunt who can’t keep her son from roaming and being homeless, even though he had access to a home and mental health help, he just will never take the help.

Anyways that’s my old man rant, i know it’s not the most PC view but after seeing your spouse assaulted by someone who just gets revolving door treatment, you wonder what the heck we are doing to help anyone here.

[–] AcidiclyBasicGlitch@sh.itjust.works 3 points 1 week ago* (last edited 1 week ago)

I understand, but the question is what happens to people when they get taken off the street? If the litmus test for locking somebody up against their will is "mental illness? Yes/no?" you have to consider how many non-violent people that includes.

What is the goal when you take someone into custody? Is it to help the person get treatment and get back on their feet, or is it just to take them away so you don't have to see them/be bothered by them?

The reason it became more difficult to hold people against their will under Reagan was bc he wanted to make a bunch of efficiency cuts/close down mental health hospitals. If you have nowhere to send people for treatment, do you just throw all mentally ill people in with people who have committed violent crimes?

That's what they used to do way back in the day, and they stopped doing it for good reason. You had horror stories of innocent and wrongly detained people being thrown into absolute hellholes (which nobody, even criminals should have been placed). I remember one case in a Pennsylvania sanitarium where due to issues with over crowding, a mentally ill man who was barely able to function on his own was just thrown into a cell with two violent individuals. They tortured and murdered him within 24 hours. Devolving back to this kind of practice isn't a solution to treating mental illness, it just locks it behind closed doors so society doesn't have to see it.

Under Trump, you have proposals like this to make it easier to hold people against their will, along with simultaneous cuts to public assistance for mental health and housing. You also have privatization and profiting by his administration and other politicians by taking advantage of an immigration system that detains people in mass. Aside from anyone's beliefs on immigration, it's important to consider how many people have just disappeared or died in these overcrowded detention centers.

It's hard to imagine a more clear recipe for disaster, or a more slippery slope of making a broad exception to populations who deserves human rights and safety based on a relatively small subset of that population.

I said this in another reply, but the oligarchs breaking current systems and safety nets while creating policies that prey on vulnerable people in desperate situations for their own profit, actually display some pretty clear behaviors that indicate mental illness.

Call it callous and unemotional traits. Call it psychopathy. Call it whatever you want. Predatory behavior for personal gain is a danger to society. The day these people are comfortable being held against their will in the prisons they've created for their own profit, and forced to get "treatment" for their own mental illness, is the day I feel comfortable with them doing it to anyone else.

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