[fishyjoe]

Been using Lifestance for my therapist/psychiatrist since it was one of the few places that took Medicaid.

Calling it a digital pill-mill seems inaccurate based on my experiences, but maybe other providers within the system are shadier than the ones I've interacted with.

My main complaint is that I've met with multiple therapists and none of them are really academic like I want my therapists to be. Good vibes does not work for me, show me some data.

[rideontime]

That's exactly the "therapist vs. psychiatrist" divide mentioned in the article. If you want "academic," you aren't going to get it from people paid the same as “'mani-pedi or salon haircut' workers."

[jeffreyrogers]

Psychiatrist is an MD (or DO) who has completed residency and can prescribe drugs. You can find therapists who have PhDs who are equal to or superior to psychiatrists in their knowledge and skills.

I don't really see any reason why a psychiatrist would be any better than a therapist (unless you need to be prescribed psychiatric drugs) once you control for general intelligence and experience. Very little of the med school education is relevant to what a therapist does.

[ImPostingOnHN]

>Psychiatrist is an MD (or DO) who has completed residency and can prescribe drugs.

Correct on the important points here:

- They are trained as a medical doctor

- They went though an additional 4 years of training during residency as a medical doctor.

- Due to that additional training beyond PhDs, they are granted prescription privileges.

>You can find therapists who have PhDs who are equal to or superior to psychiatrists in their knowledge and skills.

You can, but:

- You usually won't, if we were to pick an example at random from "therapists".

- That isn't the sort of therapist we're discussing here, as the article points out.

- A PhD can be in anything, not just psychiatric disorders.

- A PhD requires significantly less training in treating patients than an MD.

>I don't really see any reason why a psychiatrist would be any better than a therapist

For the above reasons. The vast majority of self-labeled "therapists" don't go through as much training, and most of them are glorified life coaches. I don't intend to besmirch all therapists, but it should be clear to everyone that literally anyone can wake up one day and declare themselves a "therapist", and they magically become one, equal to every other "therapist", as far as legally required qualifications go.

Due to this, they're ill equipped to identify actual serious disorders that need better treatment than good vibes, like bipolar disorder. Trying to "tough that out" with a patient, whether because: the therapist doesn't want to admit they need an expert, as it means acknowledging the above hierarchy; or because the therapist can't prescribe so their inclination is nonprescription options; or because the therapist simply doesn't have the training to identify the disorder; it's a recipe for disaster.

[FireBeyond]

On the therapy side, though, I'd hazard a guess that if their PhD was in an appropriate discipline, it would show at least some potential that they take this seriously, rather than "what is the minimum effort and education I can undertake to throw my shingle out as a therapist?"

[hirvi74]

> * they're ill equipped to identify actual serious disorders that need better treatment than good vibes, like bipolar disorder. Trying to "tough that out" with a patient, whether because: the therapist doesn't want to admit they need an expert, as it means acknowledging the above hierarchy; or because the therapist can't prescribe so their inclination is nonprescription options; or because the therapist simply doesn't have the training to identify the disorder; it's a recipe for disaster.*

I believe too much credit and merit is given to psychiatrists. I'm not arguing that an average psychiatrist is less knowledgeable than an average psychologist, therapist, or licensed councilor/social-worker. I, as well as much of society, benefit from the existence of both fields.

However, despite psychiatrists going through a more academically and scientifically rigorous training program, I often find the work of psychiatrists to be anything but scientific. If anything, psychiatry is more of an art than a science.

I try to have clemency for the field psychiatry, but it can be difficult at times. We are talking about a field that has to work with the nebulous black-box that is the human mind, which is no easy feat. To my understanding, we treat mental disorders as if they are organic diseases, and many of the said disorders, if not all, have consistently failed to demonstrate any reliable evidence of an organic etiology or biomarker for diagnostic purposes beyond a reasonable doubt. The field also relies on completely arbitrary heuristics based on vague symptoms to diagnose conditions many of which have significant overlap.

I have read plenty of peer reviewed psychiatric papers and journals. While it is not my field of expertise, I have noticed that in much of the academic and scientific literature there seems to be a better attempt at making a quantitative assessments in terms of the efficacy of various treatments. Obviously, nothing is perfect, but that is neither here nor there.

Speaking of treatments, we also have countless medications used to treat psychiatric conditions with little more than hypotheses as to how or why many of the commonly used medications actually provide relief.

I have been diagnosed with ADHD, and I had to go through many rounds of psychometric testing and questionnaires in order to receive a diagnosis (administered and proctored by a Psy.D). After I received the diagnosis, the treatment from psychiatrists have been nothing more than throwing pills at a wall and seeing what sticks. After over a decade of treatment from a multitude of medical professionals, there has yet to be a single attempt to quantifiably measure whether or not the medications I have trialed actually provide relief. During the whole entire decade long ordeal, I have never once had blood drawn, thyroid checked, a sleep study, neurological evaluation, etc.. If I quack like a duck, waddle like a duck, then I am a duck, right?

Anyway, while psychometric testing practices are not without subjection to plenty of scrutiny and criticism, such testing still seems to have been the only attempt at some sort of empirical analysis in my entire treatment process. Everything else has been nothing more than a series of brute-forced attempts.

If the success of treatments are predominately measured by the greatest reduction in symptoms with the least amount of adverse side-effects, then I sometimes wonder if a pharmacists with training in various mental conditions could almost entirely replace psychiatrists?

[ImPostingOnHN]

I am not quite sure how your post relates to mine, but your struggle seems tough. As someone who also has ADD, I can sympathize.

Consider letting go of your strict expectation of measurement (a blood draw, for example, wouldn't evaluate if you're feeling better or not, nor would a thyroid test), and evaluate for yourself if a treatment is making you feel better or worse, more effective or less, over a sufficient observation period. If worse, bring it up with your care provider.

Also consider the possibility that ADD isn't something you can therapy away, but it is something you can control some negative side effects of, with medication, and honestly it's kind of a superpower. Many successful people have had it.

Anyways, I'm sorry it's taken so long for you to feel good about yourself. That sucks.

[hirvi74]

I appreciate your sympathetic and empathic vibes. What ever struggles you may be going through/gone through, I hope you know I feel the same for you.

My point, which I probably failed to convey, was that the field of psychiatry is about 50% bullshit. Psychology is probably about 75% bullshit. Arguing which is more equipped to treat a condition is like arguing if either Greek Oracles or Astrologers can predict the future better.

I would love to had a long format discussion with a psychiatrist and pick his or her brain about this topic. Not necessarily from a treatment point of view. I just want their opinions and insights on topics like we are discussing in this thread.

> Also consider the possibility that ADD isn't something you can therapy away, but it is something you can control some negative side effects of, with medication

I have considered this. I've been treated for a decade now, and I can say with confidence that I figured this one out within a few months of treatment. I've tried countless treatments, multiple times, etc.. I can say with great confidence that what I am currently taking is the "least worst of them all." On an average day, I maybe get like 20% to 40% reduction in symptoms. Better than nothing, but not exactly the help I was hoping for. I'm still paralyzed by executive dysfunction, but the tricky part is that things other than ADHD can cause this, so it's difficult to separate the signal from the noise.

> honestly it's kind of a superpower

Perhaps at one time in our evolution, I would agree. However, in modern times, I strongly disagree. I do not see any situations in which it can benefit somebody. I find that many people who were successful with ADHD were successful despite of ADHD and not because of ADHD.