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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Christ_empowered on November 9, 2013, at 22:50:39
I live in the US. The only docs who focus on this are in public health, and they're over worked and underpaid (relative to private practice docs).Counselors, therapists, and psychologists also focus on the less severely ill. What gives? My doc was complaining about that to me at our last session. She told me that in the DSM, only 20ish pages are dedicated to severe mental illness. A couple hundred are dedicated to drug issues, apparently (I don't have a copy myself).
What's the issue? Is it like this all over the world? You'd think that psychiatry would = a focus on the severely ill...you know, the ones who really, really need meds and expertise.
Posted by sigismund on November 9, 2013, at 23:32:46
In reply to Severe mental illness, posted by Christ_empowered on November 9, 2013, at 22:50:39
You often mention the class issue and I guess that is a constant all over the world. But I am struck also by the differences between the Australian and the US systems. Our is way better BUT everything you said applies here in the public system....all you will get there are drugs of the predictable sort.
I injured myself in Peru and needed physio. I had to be assessed by a doctor to go into the public system. Once in, I paid around $8 a treatment.
Posted by Christ_empowered on November 10, 2013, at 9:15:19
In reply to Severe mental illness, posted by Christ_empowered on November 9, 2013, at 22:50:39
The thing is, with severe mental illness, the meds usually are predictable. Mood disorders w/ psychotic features, psychotic disorders...treatment doesn't have to involve spectacular, innovative cocktails, but it does require a trained expert, plus lots of psychosocial interventions.I'm blessed because my upper middle class, white collar family is behind me. That means I get a decent, quiet, safe place to recover, good food to eat, so on and so forth. I actually get to recover, which is rare in today's world, at least in the US.
I just don't understand why the government will spend billion$ on atypicals, but they won't focus more on services and disability to promote recovery and get people back into society.
Off my soap box now, lol.
Posted by Phillipa on November 10, 2013, at 10:01:53
In reply to Re: Severe mental illness, posted by Christ_empowered on November 10, 2013, at 9:15:19
So true. Phillipa
Posted by larryhoover on November 10, 2013, at 12:37:53
In reply to Re: Severe mental illness, posted by Christ_empowered on November 10, 2013, at 9:15:19
I think that it's inevitable that the severely mentally ill will face difficulties in obtaining adequate care. It's psychological triage at work.
I think that it goes with the definition of severe mental illness that a "successful treatment" will require more resources to have any chance of meeting that threshold.
Some practitioners won't let that stop them, but they have a limited capacity with respect to patient load. They can only see so many patients.
Your acknowledgement that you are blessed by circumstance, to have your own supportive resources available to you, while you express your concern for those who are not so lucky, is admirable. Unfortunately, collective provision of social supports, be they for hunger, or housing, or medical care, or pyschological care, will always have individuals who fall on the wrong side of the threshold for adequate care.
I think it's the human condition. We do what we can, but the need will always be greater still.
Lar
Posted by alexandra_k on November 10, 2013, at 14:13:13
In reply to Re: Severe mental illness » Christ_empowered, posted by larryhoover on November 10, 2013, at 12:37:53
I think there is a bunch of things...
Part of why substance use is so important is because intoxication / withdrawal can be mistaken for serious mental illnesses (e.g., psychosis, depression). Really important for the differential (treatment, prognosis).
Part of why we are widening the scope of mental illness is to reduce stigma about it, I think. Being given a dx of mental illness isn't the life sentence it once was (for employment etc) with - what is it now? One in 4 individuals affected at some point in their lifetime.
Part of why psychologists and counselors etc focus on what you are regarding to be 'less severe' cases is because cases that you are probably thinking of as 'more severe' traditionally anyway, weren't thought to be particularly responsive to intervention at all - even less non-medication (e.g., talk therapy) intervention.
I actually think... There are huge social problems around adequate housing, adequate nutriton, adequate physical activity levels. Really basic, basic, stuff like that. Sometimes it is due to lack of resources. Oftentimes it is due to lack of management. I really do think that poor management of resources that are there is the biggest problem. Or perhaps that is the biggest problem that (in theory anyway) should be the easiest to do something about.
God dammit. I am not going to end up working in public health.
:-/
Posted by sigismund on November 10, 2013, at 14:14:57
In reply to Re: Severe mental illness, posted by Christ_empowered on November 10, 2013, at 9:15:19
I listened to the report of the judgement against Johnson and Johnson with interest. It is exactly what I would expect. It says something about (the limitations of) our understanding of the possibilities of life that this can even occur. And it makes my skin crawl.
Posted by rjlockhart37 on November 10, 2013, at 20:39:42
In reply to Severe mental illness, posted by Christ_empowered on November 9, 2013, at 22:50:39
i was diagonised with a severe case of paranoia couple years ago....but its not main thing, the psych reports that i've got over the years, the first offical one was diagnosis with Aspgergers autism, which is a social form of autism.....then after that i got stimulants again, abused them and was taken off and then thats when i started having severe mental distortions, i thought people in my city where after me, the same cars would follow me, the same people would walk into stores i went into, and it got to the point where i thought i was being harassed and they where recording everywhere/thing i did and where planning to make a case to throw me in prison. See...what happened, i went to jail in 2008 over a issue that happened, and i got out....and 5 months after it, this harrassment started, i was sure that the people in my city where trying to harass me to kill myself, or throw me in prison....i started ignoring them, in the stores, them tailgating me on the road.... wouldnt pay attention to it, it was a feeling of being alienated....after a while it disappeared.....but still today....some of the stuff that happened was wierd..
mental disturbed people, whicch is an outdated term i think, live in their own world, they listen to voices, have distorted beliefs, some good others torment like....riddle like thinking.....when its a severe case sometimes medication only works about 40percent of it....it doesnt make all go away....when someone has a firm belief in their delusions its hard to erase....
Posted by Phillipa on November 10, 2013, at 22:11:53
In reply to Re: Severe mental illness, posted by rjlockhart37 on November 10, 2013, at 20:39:42
I never knew all this thanks for trusting us to reveal to. Phillipa
Posted by g_g_g_unit on November 11, 2013, at 2:41:22
In reply to Re: Severe mental illness, posted by rjlockhart37 on November 10, 2013, at 20:39:42
I fall into a difficult grey area: I'm severely unwell, but also intelligent and presentable. It can often create unrealistic expectations from practitioners.
But it's more complicated than that because I often fear disclosing the worst, knowing that treatment options basically suck. I think all the defiance, anger, hostility would vanish if visiting a psychiatrist meant being enabled, rather than just pacified.
My family is not wealthy, and, despite being well-educated, I don't work. I feel that, subtly, there's been less care/interest as I've gotten older, though it's difficult to know if it's just my social context and/or the fact that I'm a submissive male.
This is the end of the thread.
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