The Caste System in Medicine

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May 2, 2022 | 9 Comments

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  1. Reading Spruce’s story it’s an absolute scandal how he has been treated by people who really should know better. There is no better person to evaluate if something isn’t right than yourself.

    I have had PSSD myself for close to a decade now and I was met with similar disbelief by my GP initially and he typically prescribed more of the same (SSRI’s). Talk about lack of knowledge of ones own profession. At the end of my tether, I paid privately to see a urologist. It was he who first mentioned the possibility of PSSD and told me that there was no known cure. Up until then I had never heard of the condition.

    Luckily he corresponded with my GP and although I do not know what was said about me personally, it did at least open the door on it being taken seriously.

    If you look up what these drugs can do to people It is well documented and not uncommon, so it seems very strange to me, as a layman, I can verse myself in this area and yet many doctors seems oblivious to the obvious.

  2. Spruce, Thank you for your deeply moving post. I had hoped that the increasing RxISK evidence for the reality of PSSD, and expert, publications identifying the importance of PSSD, may have resulted in debate; or even an Editorial in Journal/s devoted to General Practice. It does not appear that it is widely understood that these drugs have been reported to have been used as a component of voluntary ‘chemical castration’ in ‘selected’ sex offenders. My understanding, from a forensic psychiatrist’s publications, and from press reports is that these offenders were advised that the effects were reversible. I do not know if this use continues.

    The words of Sir William Osler once again are brought to mind, perhaps they merit repetition:

    “Listen to your patient, he is telling you the diagnosis”.

  3. in the midst of disgust this account gave me this reflection. it highlights a psychosocial dynamic that contributes to hindering an updating process. the one whereby no one in a team likes to play the black sheep or the rebel, which would entail breaking harmony with colleagues, arguing, being criticised and frowned upon by others.

    there are not only health professionals who deny out of ignorance, personal / professional convenience, conspiracy of silence and arrogance, there are also those who lack the social courage (and social position). they may listen to you and think “wow! why shouldn’t I believe him?” but then remains silent within the team (even after reading a post like this).

    probably if an authoritative person in the team would say without hesitation that yes, that patient is suffering from pssd, it would turn out that others didn’t really have all that much confidence that pssd is not possible, but it was like a social norm.

    now it is also obvious that we point out the many negative responses we have received but this criticism I don’t know if it will be what will change things (underlines what is the current norm).

    where possible it’s better to point out to specialists the (albeit few) affirmative answers we have received in the past, so they will be more inclined to keep an open mind without even needing to be brave.

    skit maybe at the moment unworkable: to have a document gathering the positive answers of specialists on pssd, not to slap a specialist with it who doesn’t know about pssd but to embarrass him at the thought: the whole world knows and I didn’t know?

  4. Hello Spruce,
    So sorry to acknowledge you have to be treated like this.
    I hope you receive the support, acknowledgement, understanding, respect, compassion and kindness that you deserve.
    I strongly concur with Tim.
    “Listen to your patient, he is telling you the diagnosis”.

  5. Spruce, your story above is truly shocking – although probably not shocking to any of us who recognise how the system operates.

    People sometimes say that their pets receive better healthcare from their vet than what people do from their doctors and other healthcare workers. This can often be true and the reason is simple: people who go into animal care as a profession generally have a genuine passion for animals. I do not believe the same can be said for the majority of doctors. There of course some good ones, but it is my belief that the majority go into it for the status and the earning potential; and when that status is ‘achieved’, then comes ego. And with ego comes a very dangerous power dynamic.

    What you experienced with these people Spruce (and I realise not all of them were doctors and therefore the status/money dynamic is not at play in all the cases, although I would still argue a lot of ego is involved) is being on the wrong end of that power dynamic. You went to them for something – whether that was in hope of a solution to the problem, to gain recognition of what has happened, or some other reason – and instead of finding a professional wanting to understand and investigate your issue, you met the ‘ego’.

    The ‘ego’ you met responded in the way that it did for one of two reasons: a) because it knew you were telling the truth and for various reasons (which most of us here probably recognise) it did not want to admit it, or, b) it was unsure if what you were reporting could be true, but given that it knew it did not have a solution to the problem if it were true, what value was there in investigating it and potentially opening the accompanying can of worms.

    Whilst the two reasons at first glance appear different, they are actually the same: maintenance of the ‘ego’ is more important than the wellbeing of the patient and indeed the truth.

    So, having read your story Spruce, the question that comes to my mind is how can you/we turn this power balance around? Well, I believe that knowledge is power. And it is here that we find the ‘ego’s’ weakness: its severe lack of knowledge. It knows little about the mechanisms of SSRI’s and it knows little about their downstream effects throughout the body. But more and more people (outside of the world of medical egos) now know more about these things than it does. And an increasing amount is being written and spoken about in terms of the effects of these drugs. There is clear evidence and I believe the power balance will eventually turn. I heard a saying recently (I think it might be Chinese): ‘there are three things you cannot hide forever – the sun, the moon and the truth’.

  6. This is a horrible heartbreaking situation Spruce. A Sunday Times Best selling author Dr Jessica Taylor did recently draw attention to PSSD. She has thousands of followers on Twitter, Facebook. I did mention Risk’s work to her on her Fb page, but no idea whether she noticed it. Apparently there are thousands of young women online and especially on tiktok complaining about lack of libido both on and off ADs, the narrative being pushed though is that it is preferable to be Asexual and take the ‘life saving’ Meds than to make a fuss about it… Spruce I know of a GP who prescribed Citalopram to a patient quote ‘To calm their old fella down’… This GP clearly believed Citalopram affected sexual functioning. I was prescribed Sertraline in 2004 for PND(In reality just tired and stressed due to having a demanding job, a toddler and a newborn) I cannot believe that I bought into ‘The chemical imbalance’ Theory of depression. I knew Sertraline was completely knackering my libido but was scared to come off it.. GPS told me my lack of libido was a relationship issue and to get relationship counselling.. We would be told to have date night (Book the baby sitter, book the restaurant, have the Champagne) but of course ‘Afters’ was impossible as it felt like there was no impulse at all to get aroused. It was like the power was disconnected. If you take the batteries out of the remote it doesn’t work., no matter how much the mind wants it too. Of course this has a devestating impact of a relationship, with both partners worrying that they are falling short.. In 2004/5 no-one was telling me it was the Sertraline, but I knew it was. I had been on benzos for years and had managed to remain orgasmic on them. What is in ADs that knacker libido?
    Eventually in 2015 I decided to taper benzos, finally jumping off in 2017,then I decided in 2018 to start tapering my AD (By now Effexor not Sertraline) I am now down to 24mg and can say some lidido is coming back… For this I am so incredibly grateful… Having struggled with Serious Sexual dysfunction for 18 years. Spruce I really hope a cure can be found. I found meaning in life through my kids, career, interests but I at least had had an active healthy sex life from 1980 – 2004.

  7. Thank you for all of the comments.

    It still never ceases to amaze me looking back, just how badly I was treated, and at times deliberately betrayed, by the mental health team.

    It was really bad, and this post only tells part of the story.

    Almost every single person I have talked to with PSSD, tells a similar story as mine; of being disbelieved, gaslighted, with some even being diagnosed with “mental disorders”, to help “explain away”, the symptoms of PSSD.

    I have often heard of people with PSSD having their own families side with the psychiatrists, who claim the PSSD symptoms are psychological, or part of a newly diagnosed mental disorder.

    So even their own families don’t believe them, and agree with the psychiatrist, that the PSSD symptoms are “all in their head”, or part of a mental disorder.

    But with more information and evidence mounting that PSSD is a real condition, there is hope others in the future will be believed; and won’t be re traumatised by the medical establishment, in the same way people are now.

  8. Transcranial Photobiomodulation Therapy for Sexual Dysfunction Associated with Depression or Induced by Antidepressant Medications.
    Photonics 2022, 9(5), 330; https://doi.org/10.3390/photonics9050330
    https://www.mdpi.com/2304-6732/9/5/330 full text

    This review reports improvements in symptoms of sexual dysfunction caused by depression or antidepressants, depression and anhedonia through a type of transcranial laser treatment.
    Waldinger’s 2014 PSSD case report is mentioned in which a local laser treatment to the genitals had resulted in symptom improvement of genital anaesthesia.

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