bks wrote:c2w? wrote:
What easy admissions? Psychiatrists and, in fact, doctors of every kind are increasingly fucked for the exact same reason that psychiatric patients and, in fact, patients of every kind are increasingly about a thousand times even more fucked than that.
Not sure I agree. Psychiatrists, if they're "fucked", are way less fucked than their patients are on average, as you seem to accept there at the end.
I don't "seem to accept" it. I emphatically state it in terms that make it plain that I view it as the real problem. And one of epic proportions.
Doctors and psychiatrists should be seen as a "dominated faction of the dominant class", to appropriate and tweak Bourdieu's coinage, but most of their patients would decidedly not be. Makes a difference.
They should? Okay. Why? By which I mean:
(a) On the basis of what reasoning or evidence?; and
(b) As a tactical, strategic or conceptual move toward the attainment of what end?
Admitting as Dr. Levin does that you don't take time to listen to patients in great need, and also that you treat them like cash machines are pretty stark admissions for medical professionals to be making [and I'm glad for those admissions, for sure], as are the rationalizations for why your retirement portfolio justifies performing this "sick joke" of a simulacrum of true psychiatric care.
They are stark. Also human and flawed. Admitting as Dr. Levin does, that he feels shame to be well-regarded by his patients under those circumstances kind of suggested to me that he was aware of that himself. The not-very-impressive maximum credit he's due appears to consist chiefly in two things: (1) There's no indication that he prescribes irresponsibly to patients whom he knows or thinks can't benefit from it at all; and (2) There's some indication that when he knows or thinks that a patient won't benefit without talk therapy, he works to get him or her a referral.
Which is pretty much praising him with faint damns, as the saying goes. But that notwithstanding:
My question was actually "What
easy admissions?" Because "easy" was the word you used. And unless it was just your intention to choose an adjective that furthered the perception of any/all psychiatrists as inhumanly uncaring and facile individuals, I myself didn't really see what justified thus describing them.
It's all about the benjamins. And there are none. Psychiatrists are small fry in the grand scheme of the real powers that are at work here. And they're sure as hell not pulling the strings. Unlike PhRMA, actually. They are pulling the strings. They're just not pulling remotely the same strings that the evil-psychiatrists-are-drugging-your-babies narrative says they're pulling.
PhRMA is pulling the strings, we agree. But I think you may be imputing something to me that's not there, because I said "I'm happy to condemn the whole profession". It was meant to be humorous, but anyway, if what Dr. Levin described was in fact widespread and professionally encouraged, that's pretty condemnable, no?
If it were, yes, it would be. However, nothing in the article suggests that it is professionally encouraged. Or even professionally accepted as best or good or adequate practice. In fact, it's explicitly identified by everyone who addresses it as professionally profession-killing. And widespread.
The article plainly identifies the force responsible for it having become so several times. Can
you spot the culprit?
Like many of the nation’s 48,000 psychiatrists, Dr. Levin, in large part because of changes in how much insurance will pay, no longer provides talk therapy
He looked for a psychiatrist who would provide talk therapy, write prescriptions if needed and accept his insurance. He found none.
Recent studies suggest that talk therapy may be as good as or better than drugs in the treatment of depression, but fewer than half of depressed patients now get such therapy compared with the vast majority 20 years ago. Insurance company reimbursement rates and policies that discourage talk therapy are part of the reason.
When he started in psychiatry, Dr. Levin kept his own schedule in a spiral notebook and paid college students to spend four hours a month sending out bills. But in 1985, he started a series of jobs in hospitals and did not return to full-time private practice until 2000, when he and more than a dozen other psychiatrists with whom he had worked were shocked to learn that insurers would no longer pay what they had planned to charge for talk therapy.
“At first, all of us held steadfast, saying we spent years learning the craft of psychotherapy and weren’t relinquishing it because of parsimonious policies by managed care,” Dr. Levin said. “But one by one, we accepted that that craft was no longer economically viable. Most of us had kids in college. And to have your income reduced that dramatically was a shock to all of us. It took me at least five years to emotionally accept that I was never going back to doing what I did before and what I loved.”
He could have accepted less money and could have provided time to patients even when insurers did not pay, but, he said, “I want to retire with the lifestyle that my wife and I have been living for the last 40 years.”
In short: These guys (and gals) went to med school, and married, and had families with the (at-the-time) 100 percent reasonable expectation that financially they'd be in a position to send their children to college and save enough money to retire on, while themselves living comfortably during their active working years doing something they loved doing for which there was a large general demand from the broad swathe of the population that then had health insurance. Which then covered talk therapy. IIRC, up to a certain dollar-amount cap, typically. But enough to make it affordable for most patients. As well as to make sliding-scale fees an affordable practice for most shrinks.
That's hardly what you could call predatory career planning. In fact, you could call it "making a very large investment of time and money for career training that would qualify you to establish a professional practice in the healing profession treating people who sought your help at very little expense to them."
When Dr. Levin found himself faced with a whole new set of rules at age 57, he apparently didn't feel equal to seeking employment in some field other than the only one he'd ever had any professional experience working in. He doesn't seem at all happy about that, to me. And I guess he could have just said "Fuck it" and gotten his realtor's license or something. And maybe should have, although if he'd done it in 2000, he'd probably be trying to drum up business for a private scrip-writing practice right now anyway.
But whatever. That's a human-sized story. And not a difficult one to understand. It's not very admirable, certainly. But it's not really very despicable either. Unless you start from the baseline assumption that all prescription of all psychiatric drugs to all patients under all circumstances is, in and of itself, despicable.
Which I don't. Because undiscriminating wholesale demonization has just never really been my thing.
bks wrote:According to the article, there are still some benjamins to be made. You can still access them by doing what the Levins are doing, though there's less money and accessing requires ever-more contortions of professional practices. This squares with my personal experience, drawn from conversations with two of my best friends, a psychopharmacologist leaving the profession to begin cognitive behavioral therapy, and a pharmacist who services long-term care facilities. The other route to the benjamins mentioned was treating the super-wealthy class of kleptocrats who will pay lots of money, apparently, to unburden their souls.
Yes. As I said, psychiatrists are fucked. Dinosaurs. A dying breed.
PhRMA is pulling the strings, yes. But how tightly do they bind, and who did the tying, and why? PhRMA is an institution, representing one of the biggest industries in the world. Psychiatry, on the other hand is a profession. There's a chasm of difference that must be maintained as much as possible between the two, if the profession is to survive. If a profession is simply going to do the bidding of its carrying institutions, then why bother with the profession at all? Isn't that in fact what is threatened by acquiescence like Levin's on a large scale?
On a large scale? Yes. I agree with you. In the same sense that I would had you written:
If the citizenry of a country is simply going to permit its government to institute illegal and atrocious policies that include torture, indefinite detention without charges or recourse to law, and unprovoked acts of military aggression that result in near-genocidal numbers of civilian casualties, then why bother with democracy at all? Isn't that in fact what is threatened by acquiescence like [
YOUR NAME OR MY NAME]'s on a large scale?
IOW, have a heart, ffs. No one person can really be condemned for his or her failure to act as part of an organized, unified resistance that nobody knew how to organize and unite successfully.
Quite apart from which, I don't think it's accurate to say that Dr. Levin is doing the bidding of his carrying institutions. I think he got caught in a squeeze play between the carrying institution he relied on (the health insurance industry) and its preferred (to Dr. Levin) partner in profitable crime (the pharmaceutical industry).
I mean, hello, bks, are you there? All doctors together are a very small, weak and poorly organized force compared to either, let alone both. And all psychiatrists together are diminishingly so. One lone psychiatrist -- ie, Dr. Levin -- is barely any more powerful than you or I or any other lone individual is. They don't make
that much money. Most of them are probably somewhere around the middle third of the upper middle class.
There are ways out. Doctors of all stripes, for several years now, have been going to concierge practices which of course don't solve the big managed care problem, but at least represent a healthy first response to it.
Okay. Well. If you want to bring charges against Dr. Levin for negligent concierge-practice-non-joining, I'm certainly open to it in theory. What's your evidence? I mean, you know, your affirmative, applicable, and non-rhetorical evidence.
Which is why I do care what the scilons say. They've fucking won the battle for popular perception. And now people can't even see what's right in fucking front of them. I mean, who are you going to believe? The CCHR or your own lying eyes?
.
scilons a term for scientologists, I gather? I've never heard it before.
As I'm sure you know, Scientology is not the primary or best source of criticism of psychiatry in the second half of the 20th century. Academics like Michel Foucault and Erving Goffman and several others were making forceful, comprehensive criticisms of psychiatry 50 years ago completely independent of anything coming from L. Ron Hubbard, who isn't even an actual thinker as far as I know. Tarring criticism of psychiatry with the Scientology brush is a bit of a dirty trick, the CCHR notwithstanding. As would be assuming that criticism of psychiatry equals the wholesale rejection of it.
Scientology is virtually the only source for the popular criticism of psychopharmaceuticals, however. And if it wasn't for their tactical alliance with a few organizations fronting for the crypto-eugenicist Christian-nationalist extreme right wing, that would be so close to "only," the difference wouldn't be worth fighting over. And the OP (which concerned psychopharmaceuticals) elicited a very standard-issue hissing and tomato-throwing response directed at the CCHR-originated vision of psychiatry's unreserved and fully pre-granted willful evil and inhumanity, as well as at the CCHR-originated vision of all psychopharmaceuticals as pure poison, wittingly created to function as one, nothing more and nothing less.
And if I may say so: You do have to admit that there is absolutely nothing in that article that really merits those responses. I mean nothing that merits it on a prima facie basis. The article is about the pretty well advanced disintegration and collapse of talk-therapy-offering private-practice psychiatry in the United States that's jointly attributable to its non-reimbursability and the unwillingness of doctors to work for a lower income than a doctor's income, particularly when all the commitments they made when their prospects were rosier assumed the latter.
Not that you'd ever know that from this thread, though. Which I find frightening. But unsurprising. Because I have yet to see a single thread on the subject of psychopharmaceuticals here that used anything except recycled Scientology talking points. Sometimes several times recycled, granted. Because that's virtually the only kind the mainstream media uses. And the only kind, if you want to narrow that down to conspiro-friendly media, mainstream and otherwise.
Incidentally, I'm a fucking critic of psychiatry myself, as it happens. And of modern medicine generally. That's principally why I totally resent being unable to say three fucking words about my views without getting jumped on by one or both sides of the great big false fucking debate about the evils and/or non-evils of psychiatry and psychopharmacology.
Because I am telling you: It is literally impossible to have an intelligent conversation anywhere at all with anyone at all about either. It has been for years. People don't hear what you're saying. They only hear the parts that would be (or shouldn't be) in one or the other of the two sides of that debate. So they respond accordingly.
And then you
are in that debate.
We are fucking doomed.
