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sully9088 t1_iytjz3s wrote

I work in psychiatry and I also have 10 years experience working in a SICU. There should be no personal guilt involved in the health Practitioner when they provided informed consent (including potential risks, benefits, etc) and offered the current best practice to resolve an ailment. We often look back in time and cringe at the medical procedures that used to be performed, but those interventions were developed based on past experience. We only got where we are today due to the medical interventions performed in the past. We learn through past experience. Hannibal seemed to be of sound mind when he made the decision to undergo the procedures. Awen did well, and if he uses this experience to improve his practice then he will continue to do well. I don't always know if my psych patients are malingering or have alternative motives when they provide me their symptoms (I work in child psychiatry and there are times it seems my patients are trying to avoid school or home), however, I need to trust them because there is no other choice. If I choose to not believe my patient then I am risking the possibility that I will provide poor treatment to someone who truly needs it.

Edit: I didn't spell Awen's name correctly.

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Unity-Druid OP t1_iytoen2 wrote

Thanks for the insightful comment. I think you’ve summed up my experience working in psych as well. Because it would be totally wrong to assume patients are lying from the get-go, the provider simply has to do the best they can, providing informed consent and prompting self-reflection where possible, and allow the patient to assume some responsibility for giving the information they give and requesting the treatment they do. There are of course some conditions, such as munchausen’s, in which self-report of symptoms is intentionally deceptive, and in my experience the medical system is still pretty unprepared to detect and diagnose these types of issues, and it was around these types of problems that I designed the thought experiment. I really don’t have a specific clinical course I’m arguing for, because I think we simply need to learn more about the mind before our diagnostic tools will improve to a significant degree.

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LostLetterbox t1_iyulncc wrote

Curious what your thoughts are about ECT, ketamine and propofol?

Ketamine and propofol have both been shown to offer some benefit to patients suffering from depression independent of inducing seizures...

But I'm yet to run into a study that tries to isolate the medical benefit of inducing seizures relative to the anaesthetic alone, and the fact that it hasn't been systematically analysed scares the crap out of me.

If you don't want to comment for professional reasons I understand.

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Unity-Druid OP t1_iyuqo0u wrote

I have very mixed feelings about ECT. Although I've seen it help many patients, I've also seen it induce near-catatonic states and mood swings in more patients than I would like. There is also limited research on the long-term effects of ECT and whether or not ECT actually provides enough long-term relief from symptoms to be worth the discomfort and physical and psychological risk.

Ketamine and Propofol have, in my opinion, a better cost-benefit ratio, and I like that they don't induce a seizure-like response in the brain. Recent research on consciousness would seem to suggest that altering the structure of the brain under anesthesia, when the consciousness is not able to access it, may be very disorienting and uncomfortable for the consciousness.

Furthermore, advances in consciousness research have allowed development of techniques like Transcranial Magnetic Stimulation, which are much less invasive, although in my opinion inducing an electromagnetic current in the brain by any form is like using a hammer to adjust your rearview mirror.

I think unusual conscious experiences and fresh ways of looking at the world allow the consciousness to participate in positive reorganization of neural networks, which is one of the reasons I think psychotherapy and introspection are such important parts of psychiatric treatment. Medication and other physical treatments can correct the wiring, but if you repair a computer and then only download viruses all day, the computer won't last long. Retraining patterns of thought is just as important as reorganizing neural pathways.

These are just my opinions, and have nothing to do with the particulars of my job or the policies of my hospital.

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LostLetterbox t1_iyurclv wrote

Appreciate the opinions :) what scares me most is that if psychiatrists are scared to examine this properly that's a huge indictment against the industry.

If there is a held belief that makes you uncomfortable the only real scientific response is to lean in and understand it.

I get that ECT has helped many and I can't even imagine how it might help, but that's no reason to avoid understanding its therapeutic benefit separate to anaesthetic alone.

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