Parity of esteem within the biopsychosocial model: is psychiatry still a psychological profession?

Discussion in 'Other psychosomatic news and research' started by Sly Saint, Aug 19, 2023.

  1. Sly Saint

    Sly Saint Senior Member (Voting Rights)

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    Abstract
    In recent years, the Royal College of Psychiatrists has been engaged in activities to ensure parity of esteem for mental health within the National Health Service, seeking to bring resources and services more in line with those available for physical health conditions. Central to this has been the promotion of psychiatry as a profession that takes a biopsychosocial approach, considering all aspects of the patient's presentation and history in the understanding and treatment of mental disorders.

    However, there has been a drift away from considering the psychological aspects of the patient's difficulties in recent years. This potentially has profoundly negative consequences for clinical care, training, workforce retention and the perception of our identity as psychiatrists by our colleagues, our patients and the general public.

    This editorial describes this issue, considers its causes and suggests potential remedies. It arises from an overarching strategy originating in the Royal College of Psychiatrists Medical Psychotherapy Faculty to ensure parity of esteem for the psychological within the biopsychosocial model.

    https://www.cambridge.org/core/jour...l-profession/8A933EC6DC41B7FD8644BA66A6B80DE2
     
    Last edited by a moderator: Aug 19, 2023
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  2. Trish

    Trish Moderator Staff Member

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    Esteem has to be earned, not demanded.
     
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  3. JemPD

    JemPD Senior Member (Voting Rights)

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    :laugh: Really?!

    Not in my experience there hasnt - quite the reverse!
     
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  4. Hoopoe

    Hoopoe Senior Member (Voting Rights)

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    How about parity of quality standards in research?
     
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  5. Kitty

    Kitty Senior Member (Voting Rights)

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    They must be getting desperate.

    What was it Desmond Dekker sang? "Shirt it a-tear up, trousers are gone"?

    "Po-o-o-or me."
     
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  6. JemPD

    JemPD Senior Member (Voting Rights)

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    I find it so absurd that they think the psych part of BPS is being drifted away from. What planet are they living on?

    The psych part is the ONLY part that gets a look in! The bio and social are utterly ignored.
     
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  7. Simbindi

    Simbindi Senior Member (Voting Rights)

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    Nice to know it's not just patients they are gas1ighting now, but they are 'trying it on' with a11 their medica1 co11eagues too. B1ack is the new white...
     
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  8. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    I rather suspect that this is an advertising puff piece from the psychoanalytic/ psychodynamic sector of psychiatry who sense that even psychiatrists as a whole think psychoanalysis is crap.

    The first author is involved in a body that provides services in North London. It seems to be one of these quasi-commercial organisations that bids for NHS money to provide services. They want to sell psychoanalysis. Psychoanalysis has been known to be crap since the 1960s at least and maybe it is the easiest thing to axe in psychiatry now that there is no money for anything.

    The reality is that in the biopsychosocial model it is the psychological part that is devoid of any evidence base and deserves to be axed. Being service providers from whom primary care authorities will want value for money I would not be surprised if they are feeling sensitive.

    As we have observed before the great irony is the apparent complete lack of understanding of the roles of human nature displayed by professionals, whose job is supposed to be understanding human nature, in this context.
     
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  9. Ash

    Ash Senior Member (Voting Rights)

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    perception of our identity as psychiatrists by our colleagues, our patients and the general public
    ……
     
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  10. rvallee

    rvallee Senior Member (Voting Rights)

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    There should be parity of esteem between scientific medicine and biopsychosocial medicine in the same way as there should be between astrology and astronomy.

    Equating a set of vague, generic ideas that mostly amount to a belief system with a rigorous system of science is patently absurd. Of course they should not be esteemed as being equal, they're not even close to be.

    What kind of nonsense proposition is this even? Science works. Where medicine doesn't have science, things don't work. Let's stick to science, in fact let's give it back the importance it needs and deserves.

    This is exactly why we have the scientific method. If the BPS ideology had any scientific merit, it would have proven itself. Instead, it hasn't produced a single actual thing of value. So it rather is esteemed far, far above what it merits. Let's kick it down several notches to where it belongs: in the deepest grave.
     
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  11. Hoopoe

    Hoopoe Senior Member (Voting Rights)

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    I have to think back at how badly both psychiatrists I saw in my early illness years failed. They couldn't see the person in front of them because of their theories in their heads.

    They should have been able to recognize PEM.
     
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  12. rvallee

    rvallee Senior Member (Voting Rights)

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    This is simply false. It's still heavily promoted far above any merit it ever had, and Long Covid has massively amplified its clinical use. They just want more of it, but without actually proving any merit. This nonsense needs to end.
     
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  13. rvallee

    rvallee Senior Member (Voting Rights)

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    But all the esteem they currently have was demanded and handed to them without being earned. They don't know of any other way to do this.
     
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  14. duncan

    duncan Senior Member (Voting Rights)

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    Parody of esteem.
     
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  15. Sean

    Sean Moderator Staff Member

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    This.

    You guys want to be taken seriously and get a seat at the big table? Then lift your technical and ethical standards by at least an order of magnitude.
     
  16. Arnie Pye

    Arnie Pye Senior Member (Voting Rights)

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    I could never hold psychiatry in esteem for quite a few reasons :

    1) IAPT is almost completely useless but the people in charge of it are allowed to mark their own homework and come up with jaw-dropping success rates that apparently bear no resemblance to reality. The people seeing patients are poorly trained or untrained, and all some of them do is follow a script - a bit like selling something via call centres.

    2) They use really nasty drugs with dreadful side effects that can cause people to develop akathisia or tardive dyskinesia, and this is often permanent. There are many other side effects which might not improve with their vile drugs.

    3) They assume that any side effects of withdrawal are caused by worsening of the psychiatric disease, even though patients have been telling them for decades that it is withdrawal that causes the problems they have.

    4) As a result of ignoring the withdrawal issues of psychiatric drugs they have switched patients from one drug to another almost on a whim, making patients' lives a living hell.

    5) Their research is absolutely diabolical and they keep repeating the same nonsense over and over again.

    6) Some psychiatric problems are worsened by or caused by simple nutrient deficiencies e.g. schizophrenia has been found to reduce or improve when deficiencies are repaired. And this probably explains why schizophrenia and other psychiatric conditions are more common amongst the poor, and may be worsened by poor maternal diet. Do psychiatrists ever test people for nutrient deficiencies? I suspect this is a long way from standard practice.
     
    Last edited: Aug 20, 2023
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  17. Solstice

    Solstice Senior Member (Voting Rights)

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    I've only had experience with a psychiatrist when assessed for benefits so I can't speak out of much experience. I've had more dealings with psychologists. What they did was asking me how I felt or let me jot it down on paper. After that they explored my personality. The two were linked together as one being causative of the other and they had something to treat. Would you describe yourself a perfectionist? Well let's change that. Would you describe yourself as laid-back, well then let's change that eh. It doesn't matter if you feel perfectly comfortable with being a perfectionist or being laid-back, let's fix it anyway.

    Took a while for me to make the connection, but then I noticed just how batshit insane it was. Like there's some perfect equilibrium all people need to be in and the BPS-crowd is the only one that can move you there. You're never quite there yet, so there's always another session to come and another bill to pay. The trick is, you make character traits symptoms, give them sciency sounding names and then no one will question you when you "treat" them.
     
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  18. Trish

    Trish Moderator Staff Member

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    I would add to that list:

    Psychological therapy can cause immense harm even when well intended.

    Psychiatrists invented the whole field of psychosomatic medicine that is riven with:

    - patient blaming,

    - misdiagnosis and missed diagnoses,

    - misinterpretation of physically caused symptoms and syndromes as psychosomatic,

    - not believing patients lived experience,

    - gaslighting patients by using therapy to brainwash people with physical disease to believe that they are misinterpreting symptoms and to ignore them,

    - renaming 'conversion disorder' every few years so there's a plethora of names for diseases they class as psychosomatic,

    - doing terrible research that always either pretends to show their useless treatments work, or that more research is needed,

    - characterising people with hard to diagnose diseases as malingerers, leading to breakdown of families and denial of financial and medical support

    - labelling people on their medical records with names that are versions of conversion disorder so from then on they are disbelieved and refused proper diagnosis and treatment for other conditions

    - prescribing ineffective and often harmful treatments.

    - draining research funds that should be spent on proper medical research and health service funds that should be spent on real medical care

    I could go on.

    I think the whole field of psychosomatic medicine should be removed from medicine altogether and all their treatments closed down.
     
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  19. Sean

    Sean Moderator Staff Member

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    The Goldilocks theory of psychotherapy, where only the therapist knows what is just right and how to guide you there.

    Except...
    Poorly defined and permanently unresolved 'problems' are a very convenient source of income and power and excuses.

    'We are making good progress, Patient. But you will need at least another year of weekly sessions at my expensive and prestigious clinic.'
     
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  20. Solstice

    Solstice Senior Member (Voting Rights)

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    I mentioned above that a psychiatrist had to assess me for benefits, but I was seen by a psychologist first. I told her in no uncertain terms that treatment with CBT/GET had previously harmed me. After telling me she didn't think I was lying about how sick I was(documented by 3 separate physicians, but what do they know) she offered me to come in for extra sessions after the whole ordeal was over because she could really help me.

    You can't tell someone like that what you really think as they're doing your assessment, a few choice words came to mind though.
     
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