Some people think I have been over the top in my accusations and repetitive posts about Antisocial Personality Disorder and how it is pervasive in society. I think there is a larger prevalence of personality disorders, as a general concept first and foremost in some communities and cultures, both here in the U.S. and across the planet overall, but, I can only focus my concerns where I live first. That said, if my hypothesis that some areas in this country not only have a larger predominance of personality disorders (P.D.) than others (and I think the largest component of such P.D.s are of the Axis 2 cluster, and more specifically the Narcissistic, Antisocial, Histrionic, and while not fulminate Borderline P.D., traits that make some of their criteria very difficult to engage by the more typical and healthy portion of said areas), but that such areas have been effectively assimilated by such dysfunction, then we are in trouble.
Today I heard about an op ed piece in the NY Times by Carl Elliott (read it first at 1boringoldman.com, why I went there I am annoyed with myself, but transparent I must be, eh, Yoda?) and link it here for readers to peruse:
It is an ugly read, because it is pure truth, and what is the most disgusting is how so many in positions of authority and influence in academia are beyond sell outs, they are beyond whores and cowards, I think they are outright sociopathic cretins, as they put people in harms way and then do the antisocial BS of lying, denying, minimizing, deflecting, and then hideous rationalizations that just would make any honest and direct criminal wince and say “are you an asshole!?”
So, this blog post series I am beginning today, most likely to be at least 3 parts (as the third time is a charm, eh?) will first note so of the inane, ignorant, self serving, and at times just downright dangerous and litigious behaviors and choices by my “esteemed colleagues” I have to share the same title as Psychiatrist.
1. Use of meds: I could spend multiple posts on this topic alone, but, I don’t have the time or strength to go into the details that would be of some interest to readers. Let’s just start with dosages of some of the more popular meds out there, hmm? Lexapro at 20mg as an average dose, and going to 40mg at times? REALLY?! If the ratio I was told is fairly accurate, 10mg Lexapro to 30mg (if not 40mg) of Celexa means these idiots writing for 30-40mg of Lexapro are giving patients the equivalent of 90-120mg Celexa at least, if not more, and what would the FDA say to those female patients getting these dosages? Not much to support a defense for the clinician if sued for malfeasance, you think?
Then we have the Cymbalta freaks out there, thinking 120mg again is an average dose. At least a lot of insurers have been challenging this one, well, until generic Duloxetine hit the market about 2 years ago. Not much cheaper yet, though!
The next two are my favorites of late working in Community Mental Health Clinics (CMHCs), with the use of antipsychotics like Pez going onwards! Seroquel at 600mg or more for NON psychotic indications, and often for sleep alone, REALLY?! And the pervasiveness of Abilify at 30mg, again, not for psychosis, yeah, my money is that NONE of these prescribers know what the cost of that pill is these days. Still about $40 a pill, if not higher since AbominationCare took hold 3 years ago???
OH, and you gotta love the prescribing of Depakote, Lithium, Tegretol, and most atypical antipsychotics that have NO LABS ORDERED for years at a time for some of these patients. Drug levels, side effect risks, hell, just to insure compliance for some of these patients? REALLY!?
I am not going to spend much time talking about benzodiazepines, as anyone who reads here with any regularity knows my feelings about this drug class. But, forget who the hell writes for more than 4mg a day of Xanax these days, who the hell is writing for Valium in 2015?! I’ll tell you at least who 80% of them are: psychiatrists over 70 year old still practicing. Ah, the good ol’ days of the 1970s back again 40 years later. And at dosages over 30mg a day in patients over 60 years old. Classic!!!
One last pet peeve about meds, polypharmacy. Would ANY of these clinicians who routinely write for 4 or more psychotropics simultaneously, some as much as 7 different meds at a time, and not picking up scripts 5 & onwards are most likely for side effects from the earlier scripts, do they not only not have a clue, but would they write them for family members in this magnitude?? REALLY?! Let’s not even go when they write for more than 2 drugs in the same class at the same time, nah, that one is too easy. Let’s just remind readers where this mentality really started, on the in patient units. The good ol’ SHOT GUN approach to “get ’em in and then out!” by providers on the units: give the patient an antipsychotic, an antimanic, an antidepressant, and hell, throw in an anxiolytic, most likely a benzo, and one of ’em should work to get the patient stable enough to warrant discharge.
Let the follow up out patient psychiatrist figure it out. SUCKER!!!
2. I think the above link covered what is going on in academia as a general theme, but, I want to add something else to this sham of academic psychiatry. It is run by predominately old white men, and some old white women now too, who ALL belong to the APA, and these folks are the textbook description of PATRIARCHS, and the hideous side of that term mind you. They have no clue to be humble, to be negotiable, and they have no interest to have their livelihoods messed with, believe me brothers and sisters!!! And what they have done to screw up the basis of residency in psychiatry is beyond redemption. REALLY!? The fact that 90% plus of what graduating residents think and do these past 10 years at least shows that the mind is not a terrible thing to waste, but, NO ONE MINDS HAVING INDEPENDENCE AND AUTONOMY WASTED FOR THE SAKE OF A BUCK!!!
3. In patient care in general: again, I could write a lot about this, but, the basic points of failure are these simple three:
A. Agreeing to short stays, not making any effort to change what the patient is going back to after discharge, and not really coordinating care with a known outpatient psychiatrist who often knew the patient before the admission. B. Running a unit of more than 16 people acutely ill. I think that number alone sets the tone, think about it, you have to see all your patients every day, so 16 divided by 8 hours, without admissions mind you, is 30 minutes with each of them. Some that time is enough, some it won’t be, but the point to this part is running units of more than 16 patients. That is disaster waiting to happen! REALLY?! Finally, C. Writing for meds that most insurers will not inherently cover once the patient hits the real world outside the hospital walls, AND, telling these patients who are acutely ill, and have much potential more often than not until proven otherwise, that they are disabled and should apply for disability. I have a suggestion to in patient colleagues who might want to think about that latter part about disability: why don’t you suggest those who are still of reproductive ages to get sterilized and then remove one of their five senses before discharge to enhance the success of first time application for disability? It might help such patients’ chances at dependency, hopelessness, and sheer lack of will to progress! REALLY!?!?
4. For now, the last one regarding psychiatrist here for Part 1 of REALLY!?!?, the APA. Again, readers know how I feel about this “organization”, but my point here in this post is not to try to shame the leadershit, er, leadership of the APA, but, the general members. I won’t say who wrote this, but a colleague I know peripherally wrote this in one of our throw away periodicals that is well read in the profession, and it is about the Murphy attempt to enforce outpatient care while disregarding much of confidentiality and choice:
“Still, I heard the news [of the APA supporting Tim Murphy’s renewed efforts to get legislation passed mandating ALL states have outpatient civil commitment programs and releasing information to family members without patient consent first] and was terribly disappointed in the APA. The decision to support this sweeping legislation was made without a vote by the Assembly, with the knowledge that some of these issues are quite polarizing. In addition to the HIPAA disqualification, the issue of outpatient civil commitment, in particular, is controversial. Although proponents are quick to point to research that show its benefits – the research has been done specifically on Kendra’s Law in New York, where $125 million was placed into that state’s mental health system to shore up services – we don’t have the research to know if what helps is providing more services or strong-armed coercion. The text of the bill will be released in the coming weeks. At the very least, couldn’t the APA have waited to see exactly what it is we endorsed?”
What was the key word in that above paragraph to me? At the end, “…WE endorsed?” Even as this psychiatrist writes of some level of disappointment, maybe a tad of outrage, the person includes him/her self in the endorsement?
Am I the only person who believe in this principle, but, we are judged by the company we keep, and this organization is so full of shit, corruption, cronyism, and sheer entitlement, anyone with half a soul and honest commitment to patient care would not only be gagging when at the yearly APA meetings, but running for the nearest trashcan to projectile vomit when the leadership meetings commence at the beginning of the “SHOW”. And the APA conference is a show, don’t take my word on that, read this link, and think about it!
In there this: “This conference is huge. Fourteen thousand attendees. There are over 500 different sessions with 150 rooms being used to accommodate the meeting. Topics vary greatly although I have been surprised about how few there are describing new and innovative treatments.”
People aren’t going for lectures, not at the money the APA charges members alone, no, this is about pomp and pageantry, front and center!
I am done this Part 1 for now, maybe an addendum to add in the next day or so, but, come back in a few days, maybe early next week as I hope Part 2 of REALLY!?!? will entertain and enlighten.
I end with this classic picture from Blade Runner, when the main protagonist saves Harrison Ford’s character and sits down to start with this classic beginning to his epilogue, “I have seen things you people would not believe…”
To be continued…