Dr Evil – an expert in evil, yes, but is he an expert in health?
The issue of who to trust when it comes to looking after your mental health is an ongoing one. Every week I hear from guys who are having a crap time on meds, and either are stuck with a doctor who won’t listen to their concerns or they feel unable to speak up for themselves.
Doctors and psychiatrists are authority figures. They’re the ones who are supposed to know things – after all, they have the years of training to prove it. So we should just shut up and listen, right?
This is a logical fallacy known as the “appeal to authority”. Just because someone is in a position of authority doesn’t mean we have to blindly accept everything they say.
As Stuart Sorensen points out in this excellent blog post, this doesn’t mean that experts are worthless. It means that we have to be critical in our thinking and judgment when it comes to making choices about who to listen to – not an easy task. Stuart provides a handy list of questions to make this process easier.
Let’s look at them:
- Is this expert skilled in this particular area?
In the case of a GP, how much does he or she know about mental health? In the case of a psychiatrist, you might expect this to be a given, but not necessarily so…
- What do the majority of similarly trained experts think?
Don’t be afraid to get a second opinion. Mental illnesses do not fit into discrete categories like diabetes or HIV. They are not tangibly visible via testing, so we need to look to consensus expert opinion to guide how we should be treated.
- What does the evidence say?
Research the medication you’re on. Admittedly, this can be somewhat offputting because of the myriad of side effects listed for each one – this is a legal requirement, and you’ll find it for any meds, not just antidepressants or antipsychotics. See what it’s typically prescribed for. Wikipedia is actually a good consumer resource for this, as it gathers together a lot of research, all of which is linked to and you can investigate separately yourself.
- How often has this person been right/wrong in the past?
- If they’ve been wrong before have they been prepared to admit it?
- Is this person ideologically driven?
- Is this person financially driven to say this stuff?
- Are there any other forms of bias you are aware of?
- Does the expert use real data as evidence or just rely on stories and anecdote (you can make any point you like in a story)?
This cluster of questions comes down to researching your practitioner. In the same way that you wouldn’t trust your car to Dodgy Bob’s down the road without first finding out his track record, don’t trust your brain and your body to a medical professional without finding out more about them.
You may find this in itself to be difficult, as some professionals play their cards close to their chest and don’t like people knowing about them as it makes them vulnerable to having their authority questioned. This in itself is a red flag.
For gay men, a doctor who is ideologically driven may be someone with a religious belief who is going to treat you differently because of your sexuality. This is important for you to know, because…
- If you follow them and they are wrong – will there be a cost?
- If you don’t follow them and they are right – will there be a cost?
Your life is potentially at stake. Bipolar disorder in particular has a shocking mortality rate. You need to make sure you have the right support and treatment around you, and that you can trust your network implicitly.
- What research could you do to check out their assumptions?
It doesn’t hurt to start with online research. Many GPs and psychs are now publishing blogs (like the good ol’ Healthy Bear) or at least have websites and bios online. Ask for recommendations from friends – it was word-of-mouth that brought me to my last GP in New Zealand, and the level of care was the best I have ever had for both my mental and physical health.
Don’t be overwhelmed by it all. There are plenty of good health professionals out there who will be suited to your needs. Just don’t be fooled by the “appeal to authority” and remember that you are the customer.
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Very wise and true words Chris,
Yes one would assume that being a specialist that this person would know, understand and be able to empathize to say the least with a person who is suffering with mental illness, however this is not always the case, as in all jobs and I state the word jobs, for many practioners out there in the world, their once passion and want to help others is one that has become no more than a daily grind, 9-5 working day, where the reason they spent so many years training has been replaced with hours of dealing with the same old same old in their daily routine.
Different patient, similar problems, the rhetorical circle of never being able to break the cycle, many doctors out there simply write out there band aid prescriptions and send people on their way like a heard of cattle, collecting their $200 as they send their patient out the door,
Forgetting that this band aid, is only a temporary measure, and often a GP will prescribe medication that a specialist should be prescribing without giving it a 2nd thought, thinking that their handing out jelly beans or the likes of. Which causes the flow on effect and is always the beginning of the rhetorical door, that continues to swing around and around.
Patients have very little to no say in how they are treated, and we are ultamatley treated with the attitude from the practioner of shut up sit down and be grateful we are bothering with you in the first place.
Leaving the person who is suffering in the position of feeling less than worthy or feeling as though they are chasing drugs, and not sick at all, which is so very wrong.
Over all I think that the way a patient is treated should be re evaluated by those in the medical profession, and those working in this profession should be mindful and remember what and why they became a doctor to begin with.
You may be surprised to learn how many of us MH professionals agree. It takes time to change a professional culture but we’re working on it.
Cheers,
Stuart
When your psychiatrist gives you their personal cell number, you know they are on your team.
Mr. Banks, thanks for this post. I live in a rural area with few choices when it comes to psychiatrists. I recently lost mine (again!) and searched for another. I have just started seeing a chap not too far away and he is from Pakistan. He was educated partly in Pakistan, partly in Washington D. C.
I was a bit intimidated at the initial appointment, especially when, within the first 10 minutes, he asked me about my sexual preference. I was open. He asked me if answering that question made me nervous, I replied yes, a bit. Honestly, I did not what reaction I would get from a man from that part of the world. He stated, “I am your psychiatrist. I am here to help you, not condemn or judge you in any way.” I am at ease now with him and I think we are going to get along just fine.
Hi Chris,
Good post mate. I remember a previous discussion we had on the who is bipolar bear blog, if some people could recommend some g.p’s who are specialists in the treatment of anxiety and depressive disorders please please please do so, my g.p is a dermatology specialist yet he will not hesitate in prescribing med’s without doing anything else apart from getting me to fill out the good old kessler test each time I see him
Chris, I urge you to research the info I put forward to you in the who is bipolar bear blog, mate, how many people with melancholic personality types have had their brain chemistry for ever messed up by being prescribed med’s that they should never have been? All med’s are extremely dangerous when wrongly prescribed.
People, check these links out, just because the medical fraternity in N.Z is three decades behind in treating and diagnosing mental illness doesn’t mean that you have to buy into their ignorance and arrogance, don’t close your mind there are so many progressive visionary and lived experience people out there researching tirelessly. Don’t give up!
http://www.lechin.com/reasframe.htm
http://www.cancersupportinternational.com/s-a-d-s/ (deceptively titled link, but very relevant)
Yes, if you are not comfortable with the Dr, then go find another one.
Hi there Bipolar bear,
Thanks for the mention. Obliged to you.
Cheers,
Stuart