Evidence of the need for patient investigatio... - Pain Concern

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Evidence of the need for patient investigation Part 1 of 2

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This post has more than one part because of its length.

I am an advocate of people being given the tools to do their own research on the health disability they live with. I am not sure what all these tools are. I am still working on the problem. There is a need for the person with the health disability having to do their own research. Because there is much research being done which produce results that have no bearing on the person with the health disability.

The results may have no bearing because a person’s health disability is dependent on a multitude of factors which interact with each other. The research done has often only considered two variables. The published results of the research done may have been falsified

sciencemag.org/news/2018/08...

en.wikipedia.org/wiki/List_...

Research often gives a spread of treatment results. The person with the health disability has no idea where on the spread of treatment results their situation would be similar to.

For example: many people with a health disability have met the situation where certain types of weather has an effect on their health disability. The questionnaires that inquire about their health disability often do not ask what is the weather like on the day the questionnaire is being answered.

The medical consultant or doctor who we see for medical advice may not be aware that the medical paper they are basing their treatment regime on has been retracted for problems such as false data or false data analysis after its published date. Often medical consultants treat more than one condition. They research the treatment for each condition separately. If they then combine the two treatments, the busy medical consultant may not realise that the two treatments together may put too much stress on one of the body’s engineering systems. The stress may take the engineering system close to or over the engineering systems stress breakdown point. see healthunlocked.com/painconc...

During the course of trying to get help for my health disability I have seen psychiatrists and psychologists. I have had the experience of these professionals telling me one thing at interview. They then went and reported something very different than what they said they would. I have seen the records of what these professions have claimed I said at interview. What has been reported is very different both in words and in meaning than what I told them. In a number of cases they have missed out important sentence introductions for purposes of brevity and this alters the meaning of what is recorded considerably. An event which occurred at one point of time due to a combination of stresses is often assumed to occur for all time. My experience is both psychiatrists and psychologists seem to assume that a person who lacks the management skills at one point of time and thus responds to events the wrong way is going to continually respond to the same events the wrong way. The person gaining new management skills that enable them to handle that type of event well is ignored. Following my road traffic accident I have found I cannot tolerate certain stresses well. A screaming fit in the middle of the street leaves embarrassing after effects. I have had to learn to predict my internal stress is getting too high and take action to retreat from the internal high stress by various means. This management technique would often not be recognised by a psychiatrist or psychologist. The medical records can be used in research with no input from the patient whose records they belong to.

en.wikipedia.org/wiki/DSM-5 describes what DSM-5 is and some of the criticisms against it.

The DSM labels a person as having particular mental defects if certain symptoms are present. The DSM lists symptoms of behaviour, not causes of behaviour. For example: a person on the autistic spectrum was asked by a psychiatrist if they heard voices. They replied that they did. The psychiatrist prescribed antipsychotics on the basis that the person was hearing imaginary voices. Psychiatry traditionally refers to hearing voices as ‘auditory hallucinations’. The person on the autistic spectrum assumed they were being asked if they heard the psychiatrist speaking.

Dr René J. Muller is a clinician who has written a number of articles for the Psychiatric Times (psychiatrictimes.com). Psychiatric Times of 2007 (a CMP Healthcare Media publication) is I believe a monthly magazine circulated to more than 39,000 patient-care psychiatrists informing them of clinical and treatment issues etc. One of the books that I read during my research was “Doing Psychiatry wrong - A Critical and Prescriptive Look at a Faltering Profession” René J. Muller (ISBN 978-0-88163-469-3).

Dr René J. Muller writes (page 3 of “Doing Psychiatry wrong...”):

“Most wrong psychiatric diagnoses tend to stick with patients. Clinicians are reluctant to risk what they see as the possible adverse clinical or legal consequences of changing their original call, or a call made by another clinician. A particularly cruel consequence of misdiagnosing someone with schizophrenia is that the medication prescribed to quell misread “psychotic” symptoms can itself cause a tardive psychosis, so named because it takes time to develop. This is thought to be caused by an overproduction of postsynaptic dopamine receptors in compensation for the drug’s blockade of the overactive presynaptic receptors, the explanation posited for the original psychosis. Those who go off antipsychotic medication suddenly are prone to a “discontinuation syndrome,” where psychotic symptoms can occur, even if the patient did not have them initially.”

He later goes on to write (page 3 of “Doing Psychiatry wrong...”):

“...After many years of clinical work, it is clear to me that patients’ reports of abnormal thoughts, feelings, and behavior can be “stretched” to make the diagnosis of any number of mental disorders, simply by matching their symptoms to one or another checklist in the DSM. Reports of symptoms by patients are often vague and are usually taken by clinicians at face value. Few psychiatrists now have any interest in identifying the possible ways that abnormal thinking, feeling, and behavior could be due to the inauthentic and self-destructive choices a patient is making, or in looking into how unacknowledged (and sometimes unconscious) choices made long ago continue to influence a life. This is what it would be to uncover what the patient’s symptoms mean. Instead, “meaningless” symptoms are targeted with mood stabilizers, antipsychotics, and atypical antipsychotics.”

Further on he says (page 4 of “Doing Psychiatry wrong...”):

“...If, by taking a pill, patients can get around having to find out why they feel depressed, many will choose to do just that. Most psychiatrists see this pharmacological solution as an acceptable way of handling the problem.”

Many people I have spoken to concerning the examination of difficult emotional and complex life events find that it can take three or four hours of work just to try and figure out what is going on. These were people who were both mentally and physically fit. They could find that it was impossible to explain to themselves what was happening in total. In my writing, some simple paragraphs took four or more hours of work during the process of ensuring that, what I was exploring and developing, could be understood across the various peer groups. If it can take me this long, then surely a psychiatrist who is making and coming to a firm diagnosis about a patient within an hour is deceiving both themselves and their patients.

In an interview with a psychiatrist a patient is often questioned about matters they have not thought much about. The answers the patient gives can be vague, not complete, and not carefully prepared. Much relevant detail could be left out because the patient did not remember them at the time of interview. Details could also be left out because the patient may not have understood the relevance of them in regard to the interview. These issues may not be helped by the fact that the interviewing psychiatrist could be given the status of being all-knowing by the patient. They expect the psychiatrist to ask the relevant questions when needed - not realising this may not happen.

During the interview and examination conducted by the psychiatrist, it is possible that the patient will have to deal with events that potentially generate a lot of emotion. The patient has to deal with the emotional stages involved in their examination. When the patient begins to talk about an emotional event, they are unlikely to be totally aware of how the psychiatrist will understand what they are saying. The patient has to divide their attention between handling the emotion, speaking with clarity, and checking the audience's understanding (via body language). The division in the attention may result in not enough attention being paid to the clarity of meaning by the patient on their speech. This could result in what the patient actually says being perceived with different meaning to what was intended. The psychiatrist may divide their attention on listening to the patient's speech and attempting to determine the patient's emotional state. This division in attention can result in the psychiatrist not hearing every word the patient says. This by its very nature means that what the patient actually says may be perceived with different meaning (maybe opposite meaning) to what is actually the case.

(continued in part 2)

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johnsmith
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katieoxo60 profile image
katieoxo60

Hi again johnsmith, Think I read your articles back to front however my feelings on this are the same as my initial reply. Just one addition some mental health distress is not always ongoing like psychosis, there are ones like reactive depression that subside once the crisis is over. I once had a reaction to the drugs given for a major reactive depression which caused further health issues but it was not seen as that. Only those who have been through such things can understand what it feels like, my trust was also betrayed by a mental health doctor, by discussing our interview which should have remained confidential as my request. Perhaps I should not discuss personal issues but thats where my experience comes from of the services and what really happens. Enjoy the sunshine and the rest of the day must get my jobs done.

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