27

‘Dr. Goldbloom, am I crazy?’

Patients are wary of psychiatrists. Other doctors are too.


 

Photograph by Jessica Darmanin

It’s 8:30 on a Monday morning. David Goldbloom, a psychiatrist and professor of psychiatry at the University of Toronto, shows up for one of his irregular shifts in the emergency room of the Centre for Addiction and Mental Health (CAMH) in downtown Toronto. He is one of approximately 4,200 psychiatrists who practise in Canada. These physicians share the dubious distinction of working in medicine’s most stigmatized specialty. Dr. Goldbloom is currently working on a book about contemporary psychiatrists with his colleague Dr. Pier Bryden, who is a child and adolescent psychiatrist at the Hospital for Sick Children and an assistant professor in the department of psychiatry at the University of Toronto. In the following exclusive story for Maclean’s, the two doctors depict one of Goldbloom’s days in the ER. The names and identifying details of the patients described have been changed.

Being a psychiatrist is a peculiar job in many ways. While other doctors ask patients questions that few others will ever ask—“How are your bowel movements?” “What are your drinking habits?”—psychiatrists have an even more unusual mandate. We want to know about our patients’ first days at kindergarten, sexual fantasies, spending habits, moods and relationships. We interview criminals and pedophiles on a routine basis as part of our training, and spend hours on call in the middle of the night calming down individuals who believe—usually erroneously—that they are the victims of an international conspiracy or that scientists, extraterrestrial or otherwise, have implanted speaker devices in their brains. During the day, we may treat the depressed businessman, the panic-stricken college student, the substance-abusing medical colleague.

Even patients can initially be put off by us. Very few people wish or believe they or their child will ever need to see a psychiatrist. A family doctor, an obstetrician perhaps, and arguably a surgeon to remove a recalcitrant appendix or to fix clogged arteries, but not a psychiatrist. Patients enter our offices with trepidation.

Our medical colleagues also tend to be wary. Medical students considering psychiatry as a specialty usually conceal it from their non-psychiatric supervisors, surmising correctly that it will be a mark against them. “Why don’t you do something really useful? Won’t you miss real medicine? Do you really want to spend your time listening to miserable people?” Nor does the stigma lessen after training. Physicians forced to consult psychiatric colleagues for assistance with hospitalized patients frequently fail to let their patients know they have done so; as a result, when the psychiatrist appears at their bedside, the patients and their families are horrified and want to know why Dr. M felt they needed to see a shrink. “Does he think I am crazy, that this is all in my head?” The greatest compliment a surgical or medical colleague can pay us runs along the line of, “You don’t seem like a psychiatrist . . . ”

Arguably, the stereotype associated with psychiatrists’ professional identity is borrowed from the far greater stigma suffered by our patients. Patients with mental illness have historically been hived off from the majority of medical patients into asylums and, later, into large gloomy psychiatric hospitals built, like prisons, on the periphery of towns and cities. It is a relatively recent phenomenon—after the Second World War—to see psychiatric wards in general hospitals.

There is some truth to the old adage that psychiatrists have much in common with our patients. We are more likely to have had experience with mental illness ourselves or in our families than doctors in other specialties. Students who choose psychiatry tend to have more non-authoritarian attitudes, open-mindedness and a greater interest in theoretical issues and social welfare than their colleagues. Psychiatrists are also more likely to have an undergraduate degree in the arts and humanities.

I started medicine at McGill University in Montreal in 1977 with no sense that my future career lay in psychiatry. The reaction to my decision to enter psychiatry was mixed. Some relatives and friends thought I was “throwing away” a medical education or abandoning a family legacy. I come from a family of pediatricians that now extends across four generations. Others gave me the backhanded compliment that I was “too much of a regular person to be a psychiatrist.” One senior psychiatrist at McGill, a family friend, expressed her disbelief that I was going into her profession, saying, ‘You don’t like to listen; you like to talk.’ ” I am forced to admit that her observation was at least partly correct; my psychiatric training has been important in teaching me to be a better listener.

My younger self was determinedly un-psychologically minded. When I interviewed for the residency program in psychiatry at McGill, a staff psychiatrist surprised me with the question, “Have you had any sad experiences recently and can you tell me how you have dealt with them?” I thought for a few moments and replied, “I haven’t had any.” When I told my wife about the interview later, she quietly reminded me that in recent months both an aunt and a friend my age had died. I still think I answered the interviewer’s question honestly. My capacity for denial, coupled with an inherently optimistic temperament, has helped me ride out the inevitable hard times of a career in psychiatry.

The site where I work houses Toronto’s busiest psychiatric emergency service, operating 24-7 and seeing about 4,000 patients a year. Located on the ground floor of the hospital, it features a sign on the door that says “Emergency” in a huge array of languages. Most days, police cruisers can be seen in the parking lot of the building, transporting the city’s disruptive, suicidal, or simply most distressed citizens to its doors.

The ER is staffed by a rotation of psychiatrists and psychiatric residents, a team of nurses, a social worker, a ward clerk and a psychiatric assistant (who in an earlier era would have been called an orderly). Because this is a teaching hospital, the morning begins with eager but fatigued residents who have been on call for the previous 24 hours presenting their cases to the incoming shift of doctors, nurses and crisis workers. My job is to listen, look for chinks in the resident’s defence of his or her diagnosis, and identify issues and themes that can be used as a segue into teaching.

This morning, the ER waiting room is empty; the residents have seen, admitted or discharged everyone, and the whiteboard in the nursing station is blank. I like to start the day this way—not sifting through the impressions and decisions of others but encountering new patients. There remains a short-stay unit behind the ER where up to eight patients can be housed for several days of observation prior to either hospitalization or discharge. This morning, four patients are there, awaiting their daily re-evaluation. I take on one.

Luana is a 26-year-old woman who has been detained under the Mental Health Act of Ontario for 72 hours of psychiatric evaluation. She was diagnosed with a manic episode last year, hospitalized and treated elsewhere. She discontinued her medications without medical consultation six months later with no immediate consequences. However, two weeks ago, she became uncharacteristically elated, stopped sleeping, and started to behave with unprecedented sexual impulsivity.

I escort her into the glassed-in interview room. She is dressed in a hospital gown. As she talks, Luana looks frequently through the glass wall at apparent distractions—although none are visible or audible. She starts to answer questions, speaking rapidly, losing herself within her expansive answers. She describes herself as “maybe one-quarter to one-third manic” but tells me that she doesn’t need any hospitalization or treatment. I remember a patient whom I had seen during my residency, 25 years earlier, who was also in a severe manic episode. That woman had had impulsive sex with every man she could seduce in her condominium building. When the mania subsided, she was so humiliated by her behaviour that she moved. I don’t want Luana to humiliate herself or worse, even though the risk of that is imperceptible to her at the moment.

Thus the morning begins with depriving my patient of one of democracy’s fundamental civil liberties—the freedom of movement. Luana stares stonily at me as I hand her the legal document advising her of her new status. Involuntary admission in the interests of the patient or societal safety is a thankless task at the time, but I have over the years experienced gratitude from some patients as they recovered.
I dislike slow days so I am relieved to discover that two new patients are registering at the front. I ask Tish, a friendly nurse who hails from Cape Breton Island, whom I should see first.
“Allan,” she replies. “He’s really sick.”

Two weeks ago Allan stopped talking to everyone. I peer out the glass window of the nursing station where Allan sits calmly and silently with his father and his youth worker. I go to the waiting room and introduce myself and extend my hand; Allan shakes it but doesn’t make eye contact. I say why I am here, and that I want to help. I then turn to Allan’s father and youth worker to take the history. Just 20 years old, he was hospitalized at CAMH six months ago on the Early Psychosis Unit, which focuses on young people experiencing their first episode of possible schizophrenia. He could hear snatches of conversation among people he didn’t know saying disparaging things about him. He held a knife to his mother’s throat for seven hours until the police intervened and brought him to the ER. He was admitted involuntarily, improved, and was discharged on antipsychotic medication. Two months ago, he stopped it for unknown reasons.

Today he is listening and following everything and responds with nods and shakes to my questions in an appropriate way. Allan is able to agree that something is indeed terribly wrong; he still feels people are laughing at him and taunting him. He concedes he doesn’t feel safe on the streets and acknowledges his last stay in the hospital was a positive one. He is willing to come back in and to get some help. Fortunately, a bed is available on the inpatient unit where he had previously been admitted; the staff and surroundings will be familiar to him. Everybody is relieved—the youth worker, the father, Allan and me. Part of my relief is that although this young man is ill, he is not violent or threatening. Within the confines of his silence, Allan is able to acknowledge his distress. This time he enters the hospital as a voluntary patient.
I erase Allan’s name from the whiteboard. It is starting to fill up faster than I can erase names. The nurses are ready with a new case for me.

The next patient, Mohammed, is sitting in the waiting room with his cousin Abdul. As I peer out through the glass and see the two men sitting on the bench, Tish says, “The guy on the left; he’s from Ethiopia.”
Mohammed had come to Canada in 1990 to escape the war in Ethiopia; he got a job in construction. He returned to Ethiopia in 2002, thinking that the tensions there had subsided.

Three weeks ago, he flew from Addis Ababa back to Toronto. “I can’t sleep,” he says, in response to my query about what’s bothering him. He also divulges that in 1982, he went to Somalia as a refugee and was hospitalized twice psychiatrically, each time receiving electroconvulsive therapy with benefit. Beyond that, he is unable to provide much detail. He is a tall, fine-featured man in a nondescript T-shirt and shorts. He speaks softly.

Mohammed speaks English reasonably well and, although he does not display a broad range of mood, is friendly and polite. He appears bewildered. I speculate as to what is causing his confusion. Is it the huge culture shift from rural Ethiopia to downtown Toronto—even though he has lived here before? The difficulty of the journey itself? Did something horrible happen to him in Ethiopia? Has whatever affected him in Somalia in 1982 recurred? Mohammed is preoccupied with his inability to sleep and doesn’t acknowledge any other difficulties on initial questioning.

I turn to Abdul for his view. Abdul reports that his cousin was initially fine on arrival in Toronto, but that within two to three days he began to change—sleeping during the day but up all night, fearful on the streets that strangers were talking about him and claiming to be able to hear them—even though he and Abdul were inside Abdul’s car with the windows up. He also points out that Mohammed had been chewing khat daily in Ethiopia, a drug only superficially familiar to me. Finally, Abdul adds that Mohammed cannot stay with him any longer and has no place to stay. He has no money and his Ontario health insurance card has expired, although he is a Canadian citizen.

I excuse myself to look up khat online. My search locates over eight million related websites in 0.16 seconds, including video footage of people chewing and talking about the drug. It is a plant that may have originated in Ethiopia and it is a stimulant when chewed, releasing chemicals with amphetamine-like properties. Lethargy, depression, nightmares and tremors are listed among the withdrawal symptoms, and khat-induced psychosis has been described—and associated in one British study, with a high recurrence rate. Mohammed tells me that he hasn’t chewed khat since returning to Canada.

I phone Mohammed’s general practitioner, a fellow Ethiopian. I hope to get a more nuanced, culturally and historically informed perspective on Mohammed.

“Do you remember this patient?”

“Of course I do [laughing]. I saw him last week and I used to see him when he lived here before.”

“What did you think was going on with him?”

“He’s crazy [laughing]! He was bothering everyone in my waiting room and told me he couldn’t sleep. I gave him some Ativan and Risperal samples. He wasn’t like that before.”

It is clear that not much more information will be obtained. Mohammed’s symptoms, while loosely defined and of uncertain origin, are interfering with his sleep, his sense of safety, and his behaviour with both family and friends. Mohammed, Abdul and I all agree that something needs to be done.

“Would you like to come into the hospital so we can help you get some sleep and understand what’s going on?”

“Yes, that would be nice.”

I admit Mohammed to “the back” for further observation, prescribe a sedating antipsychotic at bedtime, and wonder what the hell this is.

I see two more patients before my final patient of the shift, a woman, Mimi, whom Tish had told me earlier could wait. I look for her in the waiting room but cannot find her.

“She’s gone to put money in her parking meter and maybe get a coffee,” Tish informs me.

“Should we be worried?” I ask.

“She’s not suicidal. She just doesn’t want to get a parking ticket.”
I now know that Mimi is both responsible and able to afford a car. She returns in a few minutes, apologizing for the delay.

Mimi is a 37-year-old architect by profession, married to an investment banker and mother of a 23-month-old son. Four years earlier, she had left her position at a prominent Toronto firm to be with her husband who was transferred to the London office of his company. In the wake of that move, she had felt depressed, and guilty about feeling dissatisfied and unhappy in the midst of material comfort.

She became pregnant in London, and her mood dipped further after the birth of her son, Michael. From time to time, she wondered about getting help. On the family’s return to Toronto, her family doctor, extremely concerned about Mimi’s untreated postpartum depression, sent her to a psychiatrist for a consultation, and medications were recommended. But she was breastfeeding and was concerned about not exposing her son to any risk. The psychiatrist then went on maternity leave.

Mimi is soon in tears as she describes how awful she feels, how poorly she is functioning, and how bleak her future looks to her. Although she doesn’t want to kill herself, she feels that her husband and son would be better off without her, that she is a burden to them both. She averts her gaze as she recounts that she and her husband have been sexually intimate only four times since her son was born.

Her son is eating solid foods like any two-year-old, but still wakes in the middle of the night to breastfeed and sometimes also breastfeeds during the day. I try to ask as neutrally as possible why this is continuing.
She knows intellectually that the major benefits of breastfeeding for her son have passed. But he is in a routine and so is she. In the midst of her depression, her pervasive sense of inadequacy compels her to continue to provide her son with the one thing that no one else can.

I recommend that Mimi attend an outpatient psychiatric clinic at another hospital that specializes in peri-partum disorders, because the ideal intervention will also involve her husband and son. As an alternative, I encourage her to consider reconnecting with the psychiatrist she saw 18 months earlier. She thinks these are reasonable suggestions and says that she will follow up. When she leaves the ER, I wonder if she will. I also hope that I haven’t overestimated her ability to seek help; postpartum depression is notorious for its ability to paralyze apparently competent women in supportive relationships with sometimes disastrous results.

For every patient discharged, there is the curiosity about what will unfold and the worry of not knowing. For every patient admitted, there is a cascade of events, good and bad, that will have an indelible impact on that person’s life. I was told at the beginning of my training that psychiatry was a profession that required a high tolerance for ambiguity.

Most people envision psychiatric care as the gradual unravelling of a story, with the psychiatrist monitoring symptoms as they evolve, and developing a therapeutic relationship with the patient that deepens as the months and years pass. Such lengthy relationships can be rewarding for both patient and psychiatrist. But there is a different kind of satisfaction that comes from the heat of the emergency encounter which appeals to me—the immediacy, the challenge, the help that can be provided when people are feeling at their worst.

As I wipe Mimi’s name off the whiteboard, the evening crew of three residents arrive, eyeing the list of unseen patients warily. I tell them I have no cases to hand over. It seems cold comfort to them in anticipation of a sleepless night punctuated by arrivals of people in more disarray and distress than those who visit during the day. I wish them a good shift and pack up to head home.


 

‘Dr. Goldbloom, am I crazy?’

  1. The history of psychiatry is the history of psyychiatrists. It is one to be feared. Explain it in some other manner if you can, I cannot.

    Harold A. Maio

  2. "There is some truth to the old adage that psychiatrists have much in common with our patients. We are more likely to have had experience with mental illness ourselves or in our families than doctors in other specialties."

    I have great respect for psychiatry as a profession – it is good to help people heal their bodies, and it is especially good to help people heal their minds. However, I have noticed the truth of that adage. It seems that a number of people who go into psychiatry are not entirely mentally well themselves. This is a serious problem…one wants those in this professionto be exceptionally mentally healthy for such an important task.

    It's a bit like politics: some want to go into it in order to do good – they are the people one wants in that profession. Others want to go into it because they have particularly problems (with politics: lust for power, control freakishness, etc.) that make them uniquely unsuited for the profession. I think both professions should put some effort into weeding the one from the other.

    • Hear, hear!

      I completely agree with your last paragraph, and most emphatically agree with your last statement – particularly when it comes to politicians!

      When it comes to psychiatry, at least according to my GP, the former ("some want to go into it in order to do good") are generally quickly and forcefully side-lined by the latter, who unfortunately set policy for the rest of their profession and, more alarmingly, for the rest of us.

      "Weeding the one from the other" – what a great idea. If only it were that easy…

  3. This article doesn't adequately address its tagline: "Patients are wary…".

    A signficant amount of what we refer to as "mental illness" isn't really illness at all – it's injury. Look behind the stories of a large percentage of those in the mental "health" system, and you will find victims of horrific interpersonal crime. Injury, not illness.

    Injury that we as a society – and for some unexplained reason psychiatrists in particular – don't like to speak about. Instead of properly dealing with crime – in particular child abuse – through the criminal justice system, we concentrate on its victims. And even then, rather than showing sympathy and providing a place to grieve and heal, we stigmatize them as being "less than" or "other".

    The feminist therapy movement – as misguided as it is laying all abuse at the feet of men – lobbies hard to change laws to protect victims. But where is the psychiatric/mental "health" movement in lobbying for protection of children &/or victims of interpersonal crime?

    Resoundingly silent.

    • From comments to the 2009 "Mental Health" show on CBC's "White Coat Black Art":

      "Like many ER physicians in the UK I hated seeing psychiatric patients. One night as a final year student in ER, I saw the usual half dozen overdoses treated with the usual measures of a rubber hose down the throat, tied to a gurney, unsympathetic porters assisting. The next day I rotated to psychiatry. I was going to hate this waste of my time. My first patient was one of the young women we ”hosed “ the night before. Fortunately she didn't remember me. Her story? Every time her father came home on leave from the army he raped he[r]. This had been happening since she was 8 years old, and she was now 16 years of age, and he was home again. […] I'm still ashamed of the way we acted in ER on that night & many previously"
      http://www.cbc.ca/whitecoat/2009/10/reaction-to-m

    • oh yes – I went crazy, once, 31 years ago. It had a lot to do with "interpersonal crime" – terribly psychological and physical abuse from my mother and father. The psychiatrists were no help at all. I remember one of them going around a "therapy circle" of traumatized patients, telling one after another, "You're an a*hole, you're an a*hole …". They drugged me so badly I couldn't think coherently.
      I quit the anti-psychotics, separated from my family, saw a lot of therapists who gave me crutches to walk with, but didn't heal me …
      then at 43 I found out I was gluten intolerant, and I felt radically better emotionally on a diet free of gluten/dairy and other foods that I have reactions to – far less anxious, depressed and other things. No psychiatrist or therapist had ever mentioned food sensitivities to me, that would have been thought kooky … An allergist did.
      I can say the assumed authority of the mental health profession is bogus. They don't know what they are doing. They are, relative to the rest of medicine, in the age of the ancient Babylonians (say): peddling remedies that take rough aim at people's symptoms. Sort of like throwing a splat of mud at a painting you don't like. The painting is gone, but the splat of mud remains in its place …
      And yes, where is the protection for the vulnerable, for the children who are abused? I bet my immune system problems with the gluten etc. weren't only hereditary, they were caused by mind-warping, body-warping abuse. The psychiatrists don't have an interest in advocating for abused children. The parents are often the ones who pay for the treatment. The psychiatrists are part of a medical system which is not an upsetter of applecarts, not a moral force in the world – simply a business.

  4. All of the cases in the story evoke great sympathy, and all of the patients clearly need assistance. However, I am skeptical of the ability of mental health professionals to provide the assistance they need. Too much of psychiatry is treating the symptoms while the underlying cause is unknown. Psychiatrists do the best they can, but they should also keep in mind their weaknesses. The patient should remain in control, because psychiatry has its limits.

  5. Psychiatric drugs are highly addictive and cause brain damage. The medical profession doesn't care if they turn patients into junkies. They don't care if their drug cocktails result in patients getting diabetes or heart disease. Doctors are like politicians. They only care about maintaining their wealthy, privileged lifestyles. They repeat every lie from the drug companies because lying to patients is easy. Exploring safe alternatives to poisonous psychiatric drugs… that would require shrinks to actually care.

    • Grace, a couple of things: psychosis causes brain damage, not psychiatric drugs. Some anti-psychotics may increase your susceptibility to diabetes, but all of medicine is a risk-benefit assessment. Most treatments have side effects. Your comments will serve to increase the stigma of mental illness and scare patients suffering from psychotic diseases away from seeking the care that can really help them get their lives back. Serious mental illness, such as schizophrenia and mania, is very harmful to patients, and while non-medical treatments play an important role in their care, medications are essential to prevent the damage that these diseases will cause.
      Also, if doctors only care about maintaining their "wealthy, priveleged lifestypes"(sic) they would a) move and practice in the States and b) choose almost any part of medicine other than psychiatry.

      • You're kidding, right? You're honestly trying to say that psychiatric drugs don't cause brain damage? So are you asserting that "Most treatments have side effects", but psychiatric drugs don't? Funny, I seem to remember learning from my 1st year physiology prof about the peculiar gate that identified long-term users of particular anti-psychotic drugs.

        I agree with you that one shouldn't try to scare away patients from treatment, but obfuscating the truth, and patronizing patients to boot, probably does far more to scare away patients from adequate treatment than does the side-effect risks of the drugs.

        I remember a CBC1 interview which discussed how, in the case of medical errors, patients don't sue doctors they like and trust – they only sue doctors they mistrust. I suggest that for the most part psychiatrists aren't trusted, and as a profession have done very little to garner or deserve that trust or respect from either their patients, or their fellow practitioners.

  6. Your right, anti-psychotics, especially first generation ones that are no longer routinely used, do cause some neurological issues which pale in comparison to the effects of psychotic illnesses – that wasn't my point. I'm not trying to hide that – I do think that the metabolic effects of current drugs (such as weight gain, and subsequently possible diabetes) are more common than those that affect things like your gait. I never suggested that psychiatric drugs don't have side effects, which I think is pretty obvious from my post.

    Also – the most commonly sued physicians are not psychiatrists by a long shot – those are obstetricians. I would suggest going a bit farther than a first year physiology prof to draw conclusions about current medical practice.

    • Jason, a couple of things: My point was that you appeared to be either massively uninformed, or purposely trying to misinform, when you said (in a somewhat patronizing tone btw): "Grace, a couple of things: psychosis causes brain damage, not psychiatric drugs."

      And the reference to my physiology prof had nothing whatsoever to do with current medical practice – only with your odd assertion that "psychosis causes brain damage, not psychiatric drugs."

      Furthermore, the tagline of this article, as well as its content, suggest that neither patients nor fellow MDs trust ("are wary of") psychiatrists. It seems pretty obvious that they aren't sued more often because their patients are already so marginalized a) just by virtue of being their patients and b) because they are already vulnerable due to whatever condition brought them into treatment. I can't imagine any lawyer would be eager to take their case: there would be little possibility of a successful suit.

      • I apologize for the apparent tone of the message, I did not intend at all to be patronizing. I'm neither massively uninformed or trying to misinform people. My point in saying that psychosis causes brain damage, not psychiatric drugs, was because as a matter of scale I believe psychosis is much more harmful to the brain, which you can see as deterioration of grey matter in schizophrenics on MRI, for example. I am just frustrated with the anti-medication talk out there. It scares people who could truly be helped away. Nobody is denying that there are side effects to these medications, but like I said its a risk-benefit assessment and a matter of scale.

  7. Some neurological issues? How about 50% long term incidence of irreversible, disfiguring and sometimes excruciatingly painful nerve disorders. Tardive dyskinesia. Tardive dystonia. And those are only the visible muscular manifestations. A few ethical researchers believe that the drug-induced brain damage done to the muscle system is equalled by the drug-induced brain damage done to memory and thinking.

    And side effects? Drug-induced diabetes is not a side effect. It is a life-ending illness. Drug-induced strokes are not a side effect. They are life-ending complications.

    Big Medicine is a copycat of Big Tobacco.

  8. If one needs help and is wary of drugs, see a psychologist…and whether one ends up seeing a psychologist or psychiatrist, listen to your "inner voice" if you don't feel comfortable. There are many poor doctors out there and it is hard to keep trying when you may not be at your best…but from personal experience, keep trying, keep your head up and try some bibliotherapy of your own because doctors are there to point you in the right direction; inevitably, you need to do the work :) A great place to start is with resources created by Dr. David Burns. Peace.

    • Sorry, but that's the last thing a person with real mental health problems should be doing. If psychologists were, on the whole, as competent and devoted to science as David Burns appears to be, then I'll grant you that that might take care of large numbers of people with depression. HOWEVER, it should be duly noted that Burns is a psychiatrist, not a psychologist, and Burns advocates drug treatment when necessary.

      In reality, if you think psychiatrists go into the field because they're more messed up than the average person, the psychological profession is 100 times worse. At least when you're seeing a psychiatrist, you're seeing somebody who had to have it together enough to get through medical school. Psychologists have liberal arts degrees in psychology, a subject any idiot can get a degree in.

      While there are a small minority of psychologists who are rigorously committed to scientific treatments for mental health problems, the vast majority practice absurd pseudoscience about "trauma theory" (trauma being, you know, feeling judged by your parents as a child), gaining "insight" into your problems and experiencing "burried emotions."
      And of course, they don't actually attempt to help anyone because "you have to do the work yourself."

      This is all fine and dandy if you're a mentally healthy and stable person who just happens to be going through a really hard time. Why not have some fun navel gazing? And yes, trauma theory seems to work for some people who are healing from REAL trauma.

      However, for people with clinical depression or anything more severe these approaches are just going to make matters worse–unless there happens to be a genuine trusting relationship in place. In my observation, a lot of psychologists can't even recognize a mild organic mental illness when they see one.

  9. Freudian Fraud?

    What? Questions about the first day of kindergarten?? Questions about sexual fantasies?? Why the Freud-speak in this enligtened age Dr. Goldbloom?

    What could these particular questions have to do with serious mental illnesses likje schizophrenia, manic depression or other psychoses?Why would a 2010's psychiatrist base a diagnosis on Freud's 1800's unscientific, unproven musings.

    A reading of Freud's primary " research" would cause even a layperson to gasp, at the foolishness of taking it seriously. The same is true of his Wolf Man "research." Read it and weep folks,at the influence it has had in treatment of the mentally.

    In fact, Freud's ideas are only cultural myths, promulgated by too many professionals.

    With respect, I was surprsed to see it here.

    freud's

  10. I would like to congratulate the photographer on the amazing photographs in this article. Maclean's features one of the best selection on pictures to match the articles, and these two are probably the finest example I've seen lately. Thank you for such deep visual analysis of the Doctor in his workspace!

  11. Yes, I was interested in what was included, and more importantly excluded, in the first paragraph. Some things are notable in their absence.

    Dr. Goldbloom interviews "criminals and pedophiles", but apparently no victims, and no-one in genuinely warranted personal distress, only "individuals who believe—usually erroneously—that they are the victims of an international conspiracy or that scientists, extraterrestrial or otherwise, have implanted speaker devices in their brains", or "the depressed businessman, the panic-stricken college student, the substance-abusing medical colleague". Oh and, apparently, kindergarten grads with sexual fantasies.

    • I've been told, in confidence, that the parent of a murder victim of a very notorious serial sexual murderer (I won't go into details) has trouble coping and has been known to occassionally check him/herself in for treatment. The average pedophile has over 100 victims. So, would they all be considered to be the delusional "victim of an international conspiracy", or just a "depressed business(wo)man"?

      And if they showed up at your ER, would you REALLY be asking them questions about their "first days at kindergarten, sexual fantasies, spending habits, moods and relationships"? I'm sorry, but that sounds incredibly patronizing and frankly contemptuous of your patients.

      I'm sorry to say this, but given what you've chosen to write about so far, it's no wonder no-one trusts your profession.

  12. Just a thought.

    Among other positive e-mails from friends, I received one with the following . . .on Thursday night I watched a program on medical malpractice. The interviewer asked a neuropsychiatrist 'are there bad doctors?' The nice man replied,"Yes, but very few and they do not practice long, they usually go to Administration or Control."

  13. I too wonder about certain questions that were put to patients re kindergarten which seemed left over from left over from another era in Psychiatry, but I found that the article reflected pretty well what a psychiatrist must deal with every day in emergency. Dr Goldbloom is a senior psychiatrist and it is good that he is still doing long shifts in emergency. CAMH still has a working Emergency Department . I liked the fact that the family was included in one of the interviews and that Goldbloom took the trouble to phone a Family Doctor to find out what was going on. Too often that is not the case.

    Psychiatry like the rest of medicine has acted on faulty ideas which had to be eventually dropped from practice. But Goldbloom clearly has plenty of expertise and helps some people who are afflicted with serious mental illness stabilize. He could probably use a few beds and a more appropriate Mental Health Act to more effectively help more people. As for the current mantra " stigma" this should be pushed aside and not overused as an excuse. Proper effective treatment is the best stigma buster that I know. Psychiatry also has some obligation to sort out what are simply terrible troubles that life has forced upon people from serious medical illnesses like Schizophrenia and manic depression .

    • The questions about kindergarten are part of the Mental Health Assessment for a few reasons. #1 – did the patient have lots of friends in his/her early school days or did he/she have problems with socializing (people with schizophrenia often present with "negative" symptoms which include a tendency to isolate themselves from others). #2 – how was the patient's academic performance in school. Did it change at some point. This detailed history tells the physician if the patient was always a quiet, seclusive person or if his/her behavior has changed. It also leads into questions about home life; sexual abuse, etc. There is a necessity in cases of mental illness to rule out injuries at birth, etc. so a detailed history is taken. Then a CT scan & MRI are done as well as bloodwork to rule out physical causes for mental illness.

  14. An article I read with interest, having almost 20 years experienceas a nurse in acute adult mental health. I can tell each and every one of you if you have some concerns about how clients are treated by psychiatrists, you should look into how they are treated by the health care system. You really need to know, doctors don't run health care, lawyers do. It is all about mitigating responsibility and liability. If you step outside the boundaries set by administration, you run the risk of having your career ruined, every health authority has a blacklist of employees that don't spout the party mantra.

  15. I work in a tertiary mental health hospital, and many clients require multiple admissions because they do not take their medications consistently or stop them altogether. I never would have believed the transformations that antipsychotics can cause until I began working in this field. These medications can allow people to have the fullest lives possible, maintain careers, etc. There are a wider variety of options for these medications than ever and some are considered "weight-neutral" meaning on average people do not gain weight. It is quite rare to see a client with a movement disorder as a result of taking the medication long-term. I have found psychiatrists in general to be very client-focused, dedicated individuals who work well with their allied health teams and always take time to listen, which isn't something you always get from doctors.

  16. I was put in a psychiatric ward under false pretenses by police who were told not to file an incident report on the matter.
    Doctors were trying to cover up negligence and were then concealing everything from my family and they set out to make it look like I was mentally ill instead of seriously medically ill.
    My medically induced psychosis from their failure to treat was made to look like mental illness.
    I was kept in a psychiatric hospital hooked up to IV antibiotics for weeks and doctors were then secretly brought over to treat me medically..
    The deceptive practice of doctor is beyond believe.
    I wonder how many other medically ill people have been deemed mentally ill to cover up negligence.
    What the doctor did to me medically has life threatening complications and my condition after ward included abnormal gait,latency of speech and inability to see properly and weakness..My real condition had been critical before and after the spinal tap..I did not have any history of mental illness..
    I am currently being refused test to find out the extent of the damage to my spine and organs..That way I cannot expose any of this fraud..

  17. I had a hospital try to cover up negligent care by making it look like I had a mental illness.This was shortly after a spinal tap.Psychiatrists were more than willing to play along with this charade.Records were altered.
    They are not to be trusted in my opinion.

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