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Comment by soup10 | Hacker News Reader

Psychiatrists and their colleagues have been lobbying for increased discretion to detain people in spartan psych wards and administer drugs and other dubiously ethical procedures like ECT and lobotomies without consent or through coercion since the dawn of the profession. That is how they are taught and that is the culture they work in.

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Resident psychiatrist here. That is simply not true. [See similar comment below]. I'm a resident psychiatrist, almost all patients we admit at my institution sign in voluntarily. The times we involuntarily admit patients are when they are so symptomatic that they would very likely die without treatment (e.g. they refuse to eat because they think their food is poisoned).

Psychiatrists have no interest in detaining people, quite the opposite. Most of the time I'm dealing with patients who are feigning symptoms e.g. pretending to be suicidal to get admitted because they're homeless, and so we have to admit them lest we get sued, despite the fact there is good evidence many times an admission would be counter-productive. You have people who will sue psychiatrists if they don't admit someone and that person ends up killing themselves, and you have people who think psychiatrists are wantonly admitting too many people.

Also there's nothing dubiously ethical about ECT. It's one of the safest procedures in psychiatrist and the most effective. Many many patients consent to do ECT voluntarily.

Something you may not see being inside the industry is that there is a tendency and a fear of mental health professionals being used as a threat to enforce the overton window. "You believe Epstein was murdered? You'll be committed if you say that too publicly".

It would probably be better both for your aims and those of the parent commentator if rather than defend your practices and instances where you do practice involuntary committal, if you specified the wide range of cases where the public believes involuntary committal would happen and it wouldn't actually.

And for all our peace of mind, please do keep an eye on whether that list starts to shrink. Acquaintances who want to change the subject aren't the only ones who want to enforce the overton window.

That's completely absurd, at least here in the U.S. If a psychiatrist involuntarily admitted someone just because the patient believed in a conspiracy theory they should be rightfully sued by the patient and would certainly win the case. That would be gross malpractice.

Moreover, there is no incentive for psychiatrists to be admitting people inappropriately. Psychiatrists are physicians and want to feel like they're actually doing something useful like everyone else. I have no interest in admitting a patient that doesn't have a treatable illness. There are plenty of patients with real illnesses to treat.

I would also guess the person you originally responded to is European. I'm a Canadian child of German immigrants and the different attitudes towards mental wards on the two continents is striking. That said, the kind of abuses ryacko described are real, even if there are fewer incentives to commit them on this side of the pond.

The concern I find more reasonable, having seen the role it plays in the old world, is that the mental healthcare community over here will seek to expand its opportunities to commit that kind of abuse. And why not? You seem fairly secure in your belief that none of your colleagues would actually abuse that power if you had it.

And then there are moments when the system comes off as insane in itself.

https://en.wikipedia.org/wiki/Gustl_Mollath

>the court deemed him a danger to the public and declared him insane based on expert diagnoses of paranoid personality disorder. Mollath's forensic incarceration for seven years and the surrounding legal judgments became the basis of a public controversy in Bavaria and the whole of Germany when at least some underlying elements of his supposedly fabricated paranoid story about money-laundering activities at a major bank turned out to be true after all.

And yet large scale abuse keeps happening. We have regular huge scandals of psychiatrists abusing their power on a large scale. This makes your message that it doesn't also happen everywhere on a smaller scale, a very tough message:

There's indeed nothing dubious about ECT: it creates temporary behavior changes ... and permanent cognitive impairment. There is no real argument about this. If you're a psychiatrist, can you quickly remind me of "the first duty" ?

The problem is not even that it doesn't work. Like aversion therapy it works. In the same sense that a bullet to the head is very effective against back pain. You're causing a MUCH bigger problem than you're curing.

Here's the links with psychiatrists getting caught at large scale abuse, mostly for money, with sex a second reason, and it seems sometimes literally just for ego. From selling children to brothels and paedophiles to directly pimping out "patients" in the local prostitution scene. All done by psychiatrists, social workers, psychiatric nurses and "child protection":

https://www.france24.com/en/20190627-italy-arrests-18-allege...

https://nltimes.nl/2019/06/17/victim-sexual-abuse-youth-care...

https://sci-hub.tw/10.1257/aer.97.5.1583 It turns out NOT treating seriously kids with "serious" psychological problems has ... better outcomes than treating them.

https://en.wikipedia.org/wiki/Rotherham_child_sexual_exploit...

https://www.bbc.co.uk/news/resources/idt-sh/norways_hidden_s...

http://www.childpact.org/wp-content/uploads/2014/04/Reform_s...

It goes on and on and on. EVERYWHERE. US. Netherlands. Italy. Japan. China. Australia.

I mean how bad does it need to be before one can reasonably say "abolish the whole thing". At mimimum there need to be strong guarantees tying the hands of psychiatrists and social workers, and making sure the enforcement of patient rights reaches deep into every institution and all social work facilities.

Ah yes, nothing dubiously ethical about strapping a patient to a gurney, administering tranquilizers(to reduce convulsions) and indiscriminately shocking the brain with high voltages. Everyone that volunteers for ECT is coached into it, nobody would naturally come to the conclusion that it's a good idea.

That's just wrong. I have seen many patients request ECT (many of them are well-educated) because they've tried everything else and are medication resistant. It's only significant side effects are temporary memory issues. ECT should be used more not less, it is way safer and more effective than many medications psych or not.

Patient's are typically brought into a surgical suite, put to sleep and given paralytics as if they were having a surgery. The brain is shocked for like 10 seconds, the patient is asleep and paralyzed, no convulsions happen, no discomfort to the patient. The anesthetics wear off in a couple minutes, the patient wakes up and is able to go home, just as if it were some minor outpatient surgery.

I dunno; retaining functioning memory is rather important, particularly if one wants to hold down a job. Plus it doesn't jibe with the occasional anecdote of patients who report permanent cognitive dysfunctions after extended treatment.

Personally, I choose to believe my clinician, an experienced psychiatrist, who said bluntly to me "You don't want that. ECT makes you stupid." Loss of cognitive abilities is something I (and many techies) can't afford to risk.

The prevailing evidence suggests ECT does not appear to cause significant permanent long term cognitive impairment

https://www.sciencedirect.com/science/article/pii/S106474811...

https://www.ncbi.nlm.nih.gov/m/pubmed/2053635/

https://www.ncbi.nlm.nih.gov/m/pubmed/28617690/

> "...these summaries report that patient self- reported memory loss tends to be more persistent than the deficits that can be measured on formal neuropsychological testing. However, for those patients who do experience memory or cognitive impairment, they consider this to be a considerable source of distress for themselves and their families."

https://psychcentral.com/lib/research-findings-on-memory-and...

> "...We aimed to examine whether long-term effects of ECT on discrete memory systems could be detected in patients with B[ipolar]D[isorder]... Compared with healthy subjects, patients had verbal learning and memory deficits. Subjects who had received remote ECT had further impairment on a variety of learning and memory tests when compared with patients with no past ECT. This degree of impairment could not be accounted for by illness state at the time of assessment or by differential past illness burden between patient groups..."

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1911194/

I don't think there's sufficient evidence on the long-term effects yet and a high incentive for clinicians to reach for ECT as something that works when nothing else will.

The alternative is not remaining at work with high function, it's being dead.

I think GP has some kind of axe to grind with mental health practitioners.

Right, and that's not rational, is it? He's probably mentally ill and should be treated professionally.

As someone who has been "diagnosed" with mental illness, I've found that the farther away from the reach of those quacks I am, the happier and more successful my life has been. YMMV

As someone who has also been "diagnosed" I was helped a great deal by therapy and mental health practitioners.

no more than any of the other patients/victims of the mental health system

Minimal convulsions happen because they drug the hell out of patients before they are shocked. Otherwise they would be flailing around like a fish out of the water and writhing in pain like they were when they used to do the procedure without anesthesia. It's only more aesthetically pleasing for the medical staff, not safer or more ethical.

That's like saying no one would consent to surgery because it involves being sedated and cut open. There is a reason for that treatment. Whether it should be done without consent is another issue.

I suffer from depression and a generalized anxiety disorder. I've been grateful to the psychiatrists and other mental health practitioners who've treated me over the years.

I genuinely believe the vast majority want the best for their patients. In my experience, psychiatrists are far more conservative with treatment than primary care physicians are with mental health conditions (see overprescription of ritalin, antidepressants, and benzodiazepines).

The narrative that psychiatrists and other mental health practitioners are in some way nefarious further stigmatizes mental health sufferers and limits access to care.

They aren't nefarious in cartoonish villain type ways, they are nefarious in very boring and predictable human ways. Control over others, greed, politics, laziness, burnout, ignorance, ego and arrogance, narcissism. One of the posters in this thread is trying to handwave it all away "oh we do our best and and the bad stuff if because we are worried about liability". But the problems are much deeper than that and the institution itself is fundamentally flawed to the point that it's generally not a good idea to place yourself or loved ones under the care of a psychiatrist and more of a last resort.

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