Some Suggestions for Avoiding Bad Psychiatrists

"Letters, we get letters

We get lots and lots of letters"

(Apologies to the producers of the old Perry Como TV Show, if any are still living.  Damn I'm old!)



A blog reader sent me a very interesting e-mail with some important questions about the treatment one psychiatrist was providing her daughter.   Maybe I should start a newspaper advice column.  Or maybe not.  Anyway, I'll try my hand at it this one time.

The behavior of the doctor that she describes, assuming that the description is accurate, seems to be typical of the way a lot of bad psychiatry is administered these days. I thought readers might appreciate some tips on how to avoid it.

You can find many additional tips on how to pick a psychiatrist or a psychotherapist who deals effectively with family dysfunction in Chapter Ten of my book, How Dysfunctional Families Spur Mental Disorders.

The names in the letter have been changed to protect the innocent - or in this case, the name of a doctor who is perhaps guilty:

Dear Dr. Allen,

I just recently ran across your blog and became distressed because I fear my daughter is a victim of the over diagnoses of bipolar II. I took her to Dr. XXX because she was nearly suicidal after her father threw her out of her apartment (which he owns) because of her drug and alcohol use. She had no money saved to get an apartment, she wrecked her car and had no vehicle to go back and forth to college and work, and she was on a downward spiral. I told my daughter that I would help her get on her feet financially if she saw a psychiatrist (fearing she was suicidal). She found Dr. XXX’s name in the yellow pages and off we went.

Within 10 minutes he had her diagnosed as BP II. Perhaps we were relieved that there was a medical explanation for her state or perhaps his insistence that “of course this is BP II; I am an expert in the field and should not be questioned” but we did not get a second opinion. After 11 months of ‘treatment’ she is still not ‘normal’ which he blames on her not being compliant in his instruction about when to take medication, eat, sleep, etc. She does not want to continue with the treatments as the drugs are messing her up with extreme tiredness, swelling up like a balloon on the face and extremities, hypothyroid, there are constant blood tests, and on and on.

Dr. XXX refuses to help her wean off the medications stating that he can not do that when he knows she needs the meds and he took an oath. Who can help or how can we proceed to get her safely weaned off the numerous drugs she is currently taking (Equatro, lithium, lyrica, synthroid, zyprexa) to see if now that she is no longer abusing drugs and alcohol, if she can function normally? Should we get a second opinion? What should we do? Please help!

Best regards,

Mrs. ZZZ

Hi Mrs. ZZZ,

Obviously I can not make a diagnosis of your daughter or fairly evaluate her treatment based on an e-mail, but I can make some generalizations that relate to some of what you said. The following should in no way be interpreted as medical advice, but of course that does not mean you need to discount what I say.

First of all, if any psychiatrist makes a diagnosis with certitude after just ten minutes, it is not only time to get a second opinion, but to completely ignore the first one.

If a doctor does not really address a patient’s or the family's concerns but instead just says, “Trust me, I am an expert,” ditto.

The medications you describe would be for bipolar I, not II, and fibromyalgia, which is a wastebasket diagnosis for pain we do not understand. Also, your list includes two mood stabilizers (lithium and carbamazepine [“Equatro” – a brand named drug when a much cheaper generic is available]), as well as an anti-psychotic.

Whenever I see patients on such a bizarre mix of medications, some of which are for symptoms such as psychosis which they do not in fact have, the odds are extremely good that the patient has been highly overmedicated and misdiagnosed, and the doctor has been just throwing meds at the patient willy-nilly to see what sticks.

Blaming the patient for a failure of medications, while possibly true if the patient is not taking them as prescribed, is usually counterproductive. If a patient is not compliant, maybe it is because the meds are creating more problems than they are solving.

A doctor can not make a legitimate diagnosis of a mood disorder if a patient has been using drugs throughout the entire period in which symptoms occur – because the effects of the drugs can and often do mimic the symptoms of a mood disorder.

If a patient with a diagnosis that has been made under the above circumstances needs to be weaned off meds, he or she may have to consult with several psychiatrists before being able to find one that is willing to help the patient do that. But it is definitely worth the effort.

Last, I think that bipolar II is not a legitimate diagnosis to begin with, but I am in a distinct minority of psychiatrists on that point. 

Sincerely,

David Allen

Let the buyer beware!

It Aint Bad to Get Mad!

My kids have a doll called "The Elf on the Shelf," which was a gift from last year's holiday season. It sits on a shelf or perches on top of the fridge or dangles from a light fixture during the day, staring with baleful eye at the children's antics. During the night, it flies on swift wings and narks to Santa about their misdeeds. Then it returns and sits in a different spot.

My children named their elf "Harry Spotts," and registered it with the Elf on the Shelf web site.

What it says or does makes no difference, for is Santa really going to deliver coal to my children? All the threats are in vain, for if they get one less plastic rinkamadink for Christmas they will not even notice, and will continue to carry on with their "mouth farts" and other atrocities at the dinner table.

"The elf is watching!" we may exhort, and they pause. But then they continue with the "mouth farts" and other bad things, and we know, in our hearts, that they have won.

I said to my husband the other day that I need my own Elf on the Shelf. My elf will have one clear purpose: To prevent me from sending angry emails. I am an Angry Email Sender. Ever since the advent of email, I have been sending angry ones. To wit:

• The three-pager I sent my wine-sodden, fat roommate back in Stuyvesant Town to tell her she was a fat, wine-sodden bitch

• The four-pager I sent my other roommate back in Brooklyn, to explain to her that she was a nutbag whose cats urinated excessively and she needed a swift kick in the brain

• The email(s) I sent to the beloved husband some years ago, to tell him that he had offended me in various regards and I wished to explain my rightness in all things, and his wrongness

• The email I sent to certain management personnel at a particular establishment not terribly long ago, in which I used the phrase "soul crushing" to rather devastating effect, such that it is now (soon to be) a trending hashtag on Twitter

If I could have written an email to my three boys expressing my foaming furor over the continuing #mouthfart trend, I would have done so! I find email to be a very handy tool for expressing rage.

Apparently, I need an elf to stop me from hitting "send," and to kindly direct me to put my missives in the freezer for a while to cool off. My elf will be called "Mr. Jinks" or maybe "Dave."

But do I? Isn't it okay, sometimes, to say exactly what we think? Is it okay to remain silent while a coworker sits next to one at a business dinner, chewing his or her salad with a dreadful "monghgh monghgh mongrrg" sound? It is acceptable to stand by while good people get reamed, and naughty ones get rewarded? Shall we be meek and quiet while someone tells an offensive joke, or lets her cats poo on one's comforter for sport, or drinks the last dregs of the wine box? Shall we make merry with the evil poo-head who piddled on our petunias?

That's when I realized. It ain't bad to get mad. It's GOOD to get mad. It's not like Santa's going to bring me coal because I hit "send" on that email that included the words "reptilian" and "fuck-headed douche muppet" in the same sentence. And do you know how I know that? Why, Sesame Street taught me: