
Why I Quit Being a Therapist [video] - BobbyVsTheDevil
https://www.youtube.com/watch?v=f0Fi32LbXHA
======
intralizee
Key points from the video:

1) People mostly benefit from having someone to talk to about their problems.
Drugs apparently aren't much help.

2) People with the most trauma are the ones that have the least finances to
pay for treatments.

3) Most trauma is from early life.

4) The therapist has no support from colleagues and cannot talk openly. When
someone mentions suicide its recommended to send the person straight to the
hospital and to be medicated (Video author does not agree).

5) The responsibility is too much, hearing the horrors and being on the minds
of the harmed person.

~~~
phnofive
Thanks for the summary, as it’s the only way I’d have heard this person’s
view. 1) paints a broad and inaccurate view unless there is more specificity
about what kind of medication is being discussed. 4) & 5) are well taken,
though; where do professionals with confidentiality restrictions get help,
each other?

~~~
intralizee
He didn't really discuss what kind of medication.

My interpretation is he feels medication is pushed too much and rarely solves
the problem. He mentioned how people wanted to taper off and eventually stop
taking prescription medication. He didn't like how he isn't allowed to help
with that area.

Also he voiced how the cost difference for someone staying in the hospital as
an impatient is very high compared to seeing him. Insurance will try to
prevent patients from seeing him 3 days per week and only want once a week
(even if 3 days is helpful). Insurance companies have every detail about a
patient and demand it without respecting privacy.

~~~
withdavidli
Happy to see you clarified your take on point one. While summaries are
helpful, it's playing the telephone game on interpretation. It's better to
view the source material whenever possible.

------
julienmarie
Something interesting is making a mental "disorder" a sickness. A mental trait
becomes a disorder when this trait no more compatible with social norms ( it
breaks the order of things, hence disorder ). Hence the pain. And we assume a
pain is a sickness that can be cured, medicated.

Medication do not solve the root of the pain. Our brain is more than a
chemical balance. It's a neural network, trained on the training set of our
childhood. There is this fundamental age around 6-7 years old where the child
creates its identity picture, its definition of self, which becomes the
blueprint of its personality trait and evolution. This blueprint causes what
psychoanalysts call "neurosis". When digging into it, there are so many things
that makes sense in the field of psychoanalysis, and the parallels with
neurosciences and even AI are staggering.

Little nuggets I found enlightening in my day to day perception of life :

\- We learn language and the meaning of things from others ( our parents
usually ). As a consequence, we naturally expect truth and meaning to come
from outside. That's why we look for confirmation from others. That's why we
expect the people we fall in love with to give our life meaning.

\- We create our identities based on our environment. We define ourselves
against the others as to define is to draw a boundary, a difference. That's
why you'll often see the cliché in family where if the elder's dominant
trait/definition is to be good at school, then the second child will take the
opposite route.

\- Our neurosis is mostly our limiting factor to approach life. This is what
we fight against everyday, this is the wall between what we can be and what we
are.

I understand this can be seen as a controversial view for many.

I'm no psychiatrist or psychoanalyst, but was raised in a psychiatrist /
psychoanalyst family. A weird but enriching experience.

~~~
exolymph
> Medication do not solve the root of the pain.

Contradictory anecdata: Therapy never helped me until after I started taking
venlafaxine (generic Effexor) which took away my anhedonia and made it
possible to process my trauma productively, rather than continuing to wallow
in misery and dysfunction.

~~~
copperx
Another Effexor success story here. After spending most of my life suffering
through mood changes for no reason (e.g., sometimes I got sad after seeing a
color, or the way that something was arranged -- I've called this "emotional
synesthesia"), Effexor has made me a normal person again. I've been taking the
lowest dose for 7 years now, with no side effects besides dulling of emotions
(interestingly, it makes decision making hard -- for me, it now requires me to
write a pro/con list when facing a decision because there are few emotions
involved, even when buying something that should be slightly exciting, like a
new car). As someone who had a great childhood and no major traumas, it makes
me wonder if I'm one of the people who have a legitimate "chemical imbalance".

~~~
iamnothere
> (interestingly, it makes decision making hard -- for me, it now requires me
> to write a pro/con list when facing a decision because there are few
> emotions involved, even when buying something that should be slightly
> exciting, like a new car)

This is actually a known phenomenon! Emotions are key to the decision-making
process, and when they are impaired for whatever reason then you are more
likely to make suboptimal decisions. I recommend Antonio Damasio's book
Descartes' Error for a good picture of how this works.

~~~
copperx
Thanks for the book suggestion. I'm now wondering whether an overactive
emotion circuitry makes one an even better decision maker or does it impair
it? Perhaps the book will provide some insight.

------
throwaway2018-2
One of the things that really scares me about working with a therapist is that
I have suicidal thoughts a lot. Like, I don't deserve to be alive or that I
want to die. I'm still pretty productive, make a good salary, was recently
promoted. I'm scared that if I were really open about these feelings,
something bad would happen, that I could be hospitalized. Which feels like a
real step backwards to me. A step towards not actually getting better.

~~~
baselined
Suicidal ideation is different than having a plan and access to the method to
follow through.

It’s when ideation proceeds to having a timeline and decision to die by
suicide is when hospitalization is absolutely necessary. At the end of the
day, if I a person wants to die by suicide, there is very little anyone can do
about it.

~~~
gcb0
I doubt a bad therapist would not report ideation and risk it in the US.
Specially a not very good therapist, as seem to be norm in a country where
their effectiveness is diminished everywhere in favour of promoting the
unrealistic benefits of psychologist and drugs (which they will prescribe in
day one)

------
DubiousPusher
I was hoping for something insightful but really got more of the same
antiestablishment alt-med ranting you'll find elsewhere on the web.

Dude even cites his anecdotal experience to claim psych meds don't work while
at the same time claiming mental healthcare is full of psuedoscience and
vaguely endorsing something that sounds an aweful lot like Freudian
psychoanalysis. So that was pretty rich.

Well, if we're comparing anecdotes, my experience is that when a certain
relative of mine was on lithium, she didn't try to stab me in the bathtub with
a steak knife to keep the demons from getting me and when she wasn't on her
lithium, she did.

~~~
noetic_techy
I wouldn't call experience handling hundreds of patients in in a major metro
area such as NY City "anecdotal".

None of this smelled of alt-med ranting. It's the true accounts of a therapist
who saw the deficiencies of the system from the inside.

~~~
DubiousPusher
It is exactly anecdotal evidence.

[https://en.m.wikipedia.org/wiki/Anecdotal_evidence](https://en.m.wikipedia.org/wiki/Anecdotal_evidence)

This person is using their one personal experience as a general indictment of
the field rather than using any kind of controlled method to consider outcomes
which is the only way to determine if a field of medicine is doing more good
than harm or vice versa.

------
withdavidli
It's a profession that's mentally and emotionally draining. My education
background is in psychology, worked at a mental institution for a few months
as a mental health assistant. Never met a psychologist that was actively
encouraging students to go the therapist route, in fact the opposite. It's
something to think long and hard about. One memorable encounter was an aunt of
my friend literally grabbed me by the arm when she found out I was planning to
be a psychologist and advised against it. Thought "who is this crazy lady",
she was head psychologist of several institutions for the district...

~~~
kopo
>> in fact the opposite

What are you telling them to do? I have a psychiatrist friend who consults at
the medical center, in a college town. She is getting called in so much she
wants to move to a different town.

~~~
withdavidli
To know what they're getting into. It's mostly a thankless job. One of the
OP's video talks about how most therapist just wants the easy clients and
refer all their hard ones to the YouTuber. So it will vary greatly depending
on who your clients are. Imagine the difference between being a therapist for
silicon valley tech employees vs a mental hospital, prison, or juvenile
detention center.

If they do their own practice, it's much like any other business, picking the
right clients goes a long way in making your job easier and how much money you
can make.

Psychiatrist are different than psychologist. The former goes to medical
school and can prescribe drugs.

------
d33
Autogenerated transcript for those who don't want to sit at the video for half
an hour: [https://pastebin.com/XCe5Kctr](https://pastebin.com/XCe5Kctr)

------
biophysboy
I wish he had gone into more detail about the specific issues with anti-
depressants.

Most anti-depressants target serotonin or norepinephrine because the medical
industry is still more or less following the "monoamine hypothesis". The
hypothesis goes like this: monoamine neurotransmitters are crucial in the
human brain, depressed people have depleted levels of them, therefore we
should give them a drug that prevents their reuptake.

But there are issues. SSRIs take roughly 5 hours to become bioavailable, but
the positive effects of antidepressants take weeks. Why? If the core issue was
depleted serotonin levels, shouldn't the person be happier same-day?

Perhaps I'm building a strawman (I doubt med professionals believe the mono-
amine hypothesis either), but antidepressants are being prescribed at record
rates, and they are being increasingly trusted by the public. Why? The science
is trial and questionnaire, the drug efficacy is low, and the side effects are
many.

~~~
johnchristopher
> But there are issues. SSRIs take roughly 5 hours to become bioavailable, but
> the positive effects of antidepressants take weeks. Why? If the core issue
> was depleted serotonin levels, shouldn't the person be happier same-day?

Also we don't see negative effects on non-depressed people that take drugs to
reduce serotonin levels (or so I was told).

------
omosubi
What are good countries/societies that have good mental health systems? What
does that even look like? Is this a uniquely American problem?

~~~
intralizee
Canada is better than United States from my experience of living in both
countries.

I sought help with gender dysphoria in the United States. Ended up being
drugged with antipsychotics, while stuck in a hospital for two months against
my will and when I just wanted to start HRT. Doctor wrote untrue statements on
my medical records and I couldn't find anyway to sue since I was a poor
university student at the time. Almost resulted in suicide. Insurance was
billed approximately $55,000

Now I'm in Canada and I'm suicidal from the past events in life but I can see
a psychiatrist once a week. She doesn't recommend drugs and mostly just wants
to talk with trying to improve my outlook. I'm trying to get death with
dignity in Switzerland and got a positive evaluation from her after several
months. Everything in Canada is covered since I was born in Canada
(citizenship). I'm in Montréal and from what I've seen most doctors don't push
prescription drugs compared to what I saw in United States (Michigan). Canada
also has a phone number (similar to 911) but is a direct line to speak to a
nurse or social worker for help. People here actually can get help concerning
their health right away and not fear having to pay anything.

edit: I think the cost of the healthcare in the USA is why people that don't
get help, end up mass shooting and mental health stigma is a result of people
not being able to afford it; trying to rationalize it's for people really
messed up (not them).

~~~
muglug
I think the cost of healthcare has _something_ to do with it, but surely the
culprit is the gun culture that's everywhere you look the moment you leave big
coastal cities. The culture that says - "feel threatened? Reach for your gun!"

Also, second what other people are saying - I'm so sorry you were hurt for so
long. I hope that you stick around a while, continuing to advocate online for
the trans community.

~~~
OpenBSD-reich
Oh please. Guns are no more the root of gun violence than BitTorrent is the
root of digital piracy. Gun control is the cheap easy path to kudos and
biscuits, where improving the mental health system is the long tiring hardwork
nobody wants to do. Muslim examples in Europe have shown vehicles and knives
to be just as effective.

Last but not least, if you vote away my hobby/toy, don't whine like a little
piggy when I rally others to vote away your hobby/toy. Government is force
which should be used sparingly and responsibly.

~~~
pjc50
> Muslim examples

As you've almost spotted, the problem is one of _radicalisation_ rather than
either gun ownership per se or mental health. Other countries have guns. Other
countries have people with depression or PTSD. Mass shootings in other
countries are generally correctly labelled as terrorism. But people are
unwilling to realise that the American mass shooting problem is one of
terrorism.

~~~
cheez
Do you think the people driving trucks into people have no mental health
issues?

~~~
pjc50
Some of them, probably. But not necessarily all of them, and I don't think
it's a necessary precondition. I've certainly not heard of very many suicide
bombers or mass shooters that had diagnosed but unmanaged mental health
conditions.

Is someone having political beliefs that they're willing to die/kill for a
sign of mental illness?

~~~
cheez
> Is someone having political beliefs that they're willing to die/kill for a
> sign of mental illness?

I think you're making an assumption that this is what is happening. What do
unsuccessful, captured suicide bombers say?

~~~
pjc50
There are a few of these:
[http://www.spiegel.de/international/world/a-conversation-
wit...](http://www.spiegel.de/international/world/a-conversation-with-an-isis-
suicide-bomber-logistician-a-1043485.html)

[https://www.huffingtonpost.com/raza-rumi/an-interview-
with-a...](https://www.huffingtonpost.com/raza-rumi/an-interview-with-a-
suicide-bomber_b_10387052.html)

~~~
cheez
Thanks! The first one isn't very relevant because it is the leader, who can
say what he likes to indoctrinate anyone.

The second is incredibly interesting and seems very much like a brainwashing.
I can see how an otherwise normal person can end up this way.

------
analyst74
The field of psychiatry is actually undergoing a lot of changes and
improvements. With progress in understanding how our brain works at chemical
level, and newer drugs to balance the chemicals when they are out of balance.
Many of the previously untreatable mental problems are now treatable with
medicine.

That is unfortunately only available to psychiatrists, who has medical
designation.

source: a psychiatrist friend

~~~
patcon
> With progress in understanding [...] and newer drugs to balance the
> chemicals [...] Many [...] mental problems are now treatable with medicine.

The catch here is that those deciding what "progress" is, are the same
therapists and health professionals of the sort speaking in the video. And as
they said, they are under immense pressure of their own. The alternative to
"medication" is social support, of which they themselves are often primary
sources. They are overburdened themselves and often under-supported by gov, so
they're under stress (therapists for well-off people excluded).

tl;dr - they have a huge incentive (for preservation of their own sanity) to
see "medication" as progress, because it relieves their own burden (which is
structural to system).

I'm not saying this is malevolent or judging anyone to be bad, but it's
something to be wary of

Disclaimer/source: sibling is community social worker

------
carapace
reading this is like taking a time-machine back to the dark ages. It's like
the "Bring out yer dead!" scene in Monty Python's "Holy Grail", only _not
funny_.

For the love of God, use Neuro-linguistic Programming.

The "vicarious traumatization" wouldn't be a problem if you used techniques
that _don 't require_ reliving the trauma! It would be healthier for both the
therapist and the client.

There are _repeatable algorithms_ for dealing with e.g. early life trauma. You
can actually "go back in time" and relive a different life and have it
massively and permanently affect your real-world present-day life.

One of the strangest and saddest things about psychology is the disconnect
between practitioners and researchers on the one hand, and the cutting-edge
state-of-the-art techniques and "schools" on the other. (The NLP wikipedia
page is all about how it's a pseudo-science. Sheesh!)

