psychiatry

[georgia rigg]

I would like to say, Adam, that my tenure in the psych
hospital, was in the dark ages of the 70's & 80's. 
Not so--I worked there for six years, starting in
l999, so what I am reporting is within the last 7
years.  Heavy sigh!  Georgia
--- Adam Blatner <adam at blatner.com> wrote:

> Reflections on Trends in Psychiatry
> 
>     The field of psychiatry is a very mixed bag,
> with a fair number of colleagues whose 
> approach I am proud of, and, alas, many to whom I
> would not refer patients.
> 
> 1.   About psychiatrists presenting at the APA
> conference:
>              For a while, Dean Elefthery hosted
> symposia--- I was a co-faculty at the 1976 
> one, as well as Lew Yablonsky and some others; then
> Neville Murray did it around 1980---  
> including folks like Adaline Starr, etc., and me.
> Other conferences I missed around that 
> time. But in 1985, after Neville died, I took over
> this workshop and presented psychodrama 
> to an average of 25 professionals, 2/3
> psychiatrists, at a paid course at the annual 
> American Psychiatric Association conference. It was
> received well enough so that I was 
> invited back and we gave this class each year for
> about 9 years. Then it shifted more 
> towards biology and the courses stopped. Some of
> these 1985-1994 classes were co-taught by 
> folks such as David Swink, Eva Leveton, etc.
>       I stopped being active in the APA around 2001
> and began to move into 
> semi-retirement.
> 
> AH: Maybe Amy Konkle, MD in Indianapolis could get
> it going again. I believe she is a CP. 
> It would help to bring the new docs up to date.
>      AB  responding also to changes not only in
> psychiatry, but also in the financing of 
> care. The idea of longer-term in-patient care was
> more prevalent through the early 1990s. 
> Indeed, there was an expansion of such services in
> the 1980s, which ended up backfiring! 
> There were regulatory issues mixed with
> entrepreneurial capitalism. By the mid-1990s, the 
> trend was accelerating towards very short-term
> hospitalization and follow up with day 
> treatment, group work, etc., but there wasn't as
> much funding so this follow-up wasn't 
> always, well, followed up.
> 
>     Responding to requests for certain medical
> tests---the problem is that there is little 
> evidence that such tests are meaningful, leading to
> doing anything different for the 
> patients. The claims for orthomolecular psychiatry
> are, along with literally other 
> alternative medicine health care claims,
> un-substantiated. The research just doesn't 
> support that this approach does much more than
> homeopathy. (I know, some folks believe in 
> that, too!)
>       So, while there are indeed problems with the
> influence of the pharmacology industry 
> and other semi-corrupt practices, this does not mean
> that the entire enterprise is 
> meaningless. There will need to be a continuous
> process of finding the proper balance.
>         Many psychiatrists are quick to admit the
> limits of knowledge. The problem is that 
> when people are desperate and in great psychic pain,
> are incredibly self-destructive, 
> families and social networks and the patients
> themselves--- it depends--- often seek help 
> even when the experts don't have perfect tools for
> diagnosis and treatment---because they 
> aren't known yet!
> As for the status of psychodrama---well, it is
> important that we not feel too entitled. 
> Many other therapies also have blossomed and faded,
> lacking sufficient empirical evidence 
> to justify their use. Some were very time-intensive,
> costly, and many were under-developed 
> regarding any research that determined the proper
> indications and contra-indications.
>        Even psychodrama was problematic through the
> 1970s, with many then (and still 
> today, alas) doing the process with little training.
> Nor was the field fully mature then, 
> nor is it today. There are still new frontiers.
>       A number of modifications of technique have
> been introduced by Kate Hudgins and 
> others regarding working with people who are trying
> to heal their traumas. Many still 
> don't know or use these approaches.
>          So the field continues to evolve.
> 
>    More, since the 1970s some of the more recent
> developments have arisen to compete with 
> psychodrama (and other more popular approaches), so
> what's more in now is, for example, 
> the Dialectical Behavior Therapy of Marsha Linehan
> (which is skill building and has a few 
> areas in common with role training); and of course,
> the better research-documented 
> Cognitive Behavior Therapy. More, many therapists
> are integrating elements from many 
> sources.
> 
>    So, Georgia, when was it that you worked in a
> psych hospital where the "old doctors" 
> admired psychodrama, my use of John Mosher's Healing
> Circle, and my attempts to help the 
> clients create therapeutic communities?
> When did the new, just out of residency "baby docs"
> come on board? You said, "In a short 
> time, I was threated with firing if I didn't stop
> psychodrama, and forget therapeutic 
> communities." It could be that the key power wasn't
> the baby docs but the flip that 
> happened in the 80s as business managers came to
> really determine what would be done, and 
> medical directors became puppet figureheads rather
> than leaders. These collaborated with 
> the trend towards evidence based medicine in way not
> that dissimilar to the trend towards 
> testing in another institution---public schools. The
> underlying theme was 
> "accountability," and many approaches and
> professionals couldn't make the cut.
> 
> well, that's enough for now. Warmly, Adam Blatner 
> 
> 



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