Worst mental health Ask every. February 15, 2010 6:39 AM   Subscribe

Holy crap mental health AskMe.

All issues of whether this question even contains an answerable question aside, the responses from various members contain a pretty crazy amount of diagnosis dropping and medication recommending, which I think is a very dangerous precedent to set as acceptable for responses on Ask Metafilter.

DMelanogaster begins his response his response"If I were your therapist..." which, I'm sorry, is clearly an establishment of a clinical relationship with the OP. Could you imagine if the lawyers on the site began their responses to legal questions, "If I were your lawyer..."? My recommendation to DMelanogaster was that if he is going to be forming clinical relationships with posters in AskMe he put his real name, credentials and contact info in his profile so that those he's forming clinical relationships with online can contact the local ethical body governing his practice should they feel the need to do so. Every mental health consumer has the right to do this.

User Proclean states, "There really is not mystery diagnosis needed. Anxiety sucks and it presents its self in many different and annoying ways. He not only makes a diagnosis of anxiety disorder but recommends SSRIs, which worked for him. Based on what? These few hundred words of text? With how much clinical experience in making these determinations? My guess would be none.

INfo.Pump makes two diagnoses in a single post. I don't even know where to begin with this one.

A Terrible Llama says, Can you try a short acting anti-anxiety med, like Xanax, and see how you feel? I don't know what authority he feels he has to make this recommendation, which, in my opinion, is a dangerous recommendation to make, especially considering that he did not educate the poster to the high risk of overdose when taking benzos in combination with alcohol. He justifies his position, stating, "What in God's name are you talking about? I'm suggesting he get it from a doctor." Why not just suggest the poster go to a doctor? Would you recommend a heart medication to someone in advance of their seeing a professional who is qualified to make the determination of what medication might be best for them?

There is no reason any Mefite should be recommending that any other Mefite take a medication under any circumstances whatsoever.

As a mental health professional who will be backed up on this by other mental health and medical professionals on this site, please, people, resist your urge to be helpful to the poster if the only thing you have to contribute is a diagnosis or medication recommendation you are not qualified to make.
posted by The Straightener to Etiquette/Policy at 6:39 AM (179 comments total) 8 users marked this as a favorite

There is no reason any Mefite should be recommending that any other Mefite take a medication under any circumstances whatsoever.

I understand why it's happening, but you're over-reacting.
posted by mediareport at 6:56 AM on February 15, 2010 [4 favorites]


Anyone who is going to see a doctor can get advice from that doctor about how to not take certain medicines with alcohol. While I realize it's a bit of a jumo to go from "see a doctor, you ight benefit from anti-anxiety medicine" to "See a doctor for some Xanax" the former answer is 100% okay on AskMe and the latter is... not that much worse. I understand that you're really close to the issue of prescription drug abuse, and we do draw the line at people trying to obtain drugs illegally [for the most part] but there's just not a way to not have people telling people what works for them, I've done it frequently in the past. Obviously this OP didn't specifically say "I'm looking for information on medication" but many do.

I understand that you're upset, and yes people should really be caerful with their language when talking about medical and legal issues, but this seems to have touched a nerve that is only loosely related to the question and answers. Additionally, quoting answers that you think are bad prett ymuch cements our inability to remove them from the thread [as I would have done with the end of your/ATL's exchange
posted by jessamyn (temp) at 7:02 AM on February 15, 2010


AskMe would be a much less useful resource if the only permissible answers ranged from "go see a doctor/lawyer" to "only a licensed electrician/accountant can provide qualified advice on this question." Of course one may get bad, or even dangerous advice, but that's an inherent risk of "ask a crowd of strangers" vs "ask an insured professional."
posted by tyllwin at 7:04 AM on February 15, 2010 [7 favorites]


"If I were your therapist..." which, I'm sorry, is clearly an establishment of a clinical relationship with the OP.

Lawyer here. "If I were your __________" = I am not your ________. Though granted not the best choice of wording when one wants to avoid creating the impression of a clinical relationship, the statement you cited does not "clearly establish" anything, let alone a clinical relationship between the speaker and the OP.
posted by applemeat at 7:04 AM on February 15, 2010 [8 favorites]


I understand why it's happening, but you're over-reacting.

Alrighty, then. I guess everyone's a doctor now. Or, you know, they're people on Metafilter who figure they're really smart so they probably could be doctors even though they're not and can't they just logically intuit what a doctor does even though you can't really do that especially not over the Internet.
posted by The Straightener at 7:06 AM on February 15, 2010


Jess, my response to the Xanax recommendation has nothing to do with prescription drug abuse and entirely to do with the fact that Xanax might be the wrong medication for this person take if they should be taking any medication at all and recommending Xanax is doing nothing but adding noise to the conversation the poster may eventually have with an actual doctor who knows how to actually prescribe medication.
posted by The Straightener at 7:09 AM on February 15, 2010


Alrighty, then. I guess everyone's a doctor now.
So I can bring this down to the pharmacy and get my Xanax prescription filled? Great.

See the thing is, no one here actually is a doctor so there is sort of an understood extra step of going to a doctor for stuff that can only legally be done by a doctor. This is the case for surgery too, just to head off future MetaTalk threads.
posted by shothotbot at 7:12 AM on February 15, 2010 [6 favorites]


"There is no reason any Mefite should be recommending that any other Mefite take a medication under any circumstances whatsoever."

This is obviously way to restrictive. It would mean not recommending an aspirin for a head ache or pseudoephedrine for allergies/stuffed up head.
posted by Mitheral at 7:12 AM on February 15, 2010


I guess everyone's a doctor now.

*sigh* Take a deep breath. I completely agree about diagnosis dropping; folks talking out of their ass on AskMe is always annoying, but more so on medical issues, for sure. However, the quote I pulled and described as over-reacting is just that. Folks share information about what drugs have worked for them all the time here, and it's useful discussion. A Terrible Llama addressed that point directly and appropriately:

I didn't give him a prescription, tell him to get it from a friend, tell him to lie to his physician, or offer to send it through the mail. I suggested he talk with his GP about it. I'm genuinely sorry that you find that irresponsible, but it's, to my mind, a reasonable response to his question
posted by mediareport at 7:13 AM on February 15, 2010 [1 favorite]


I don't know what authority he feels he has to make this recommendation

What about every thread about flying and jetlag where people are recommending various benzos and sleep aids like ambien? These kinds of recommendations happen all the time on this site. The mods are going to have to delete all those answers now? I understand your concern, but take a deep breath man.
posted by meerkatty at 7:16 AM on February 15, 2010


IANYD, but you need a valium.

For sure it's a long slippery slope reading, asking and answering the internets for psychological/psychiatric/medical/legal/financial advice, but ultimately the OP has the responsibility to figure what might be applicable to their individual situation.

I trust Matt and Jessemyn have handled much more dangerous precedents than this one.
posted by Funmonkey1 at 7:16 AM on February 15, 2010 [2 favorites]


Take a chill pill.
posted by Obscure Reference at 7:16 AM on February 15, 2010 [9 favorites]


Streaightener, we've been here, done this, a hundred times. I'm with you (I think) about the problem with many medical/psychiatric questions, and this site has lost at least one medical professional who was a respected member over this very issue as well. It's quite similar to the regular recurrence of the "this is legal advice" debate.

There's no point tilting at this windmill. Public opinion among the MeFi membership runs strongly the other way, on a basis that is reasonable if, in my opinion, mistaken in its conclusions in *some* cases.

This is hardly the worst example of the problem, though. Lay diagnosis happens all the time on AskMe, including some really shocking stuff. Indiscriminate dispensing of advice for medication and other treatment? Check, happens all the time here. In this case, the problem really lies with the question itself. There's really nothing to be said there except "you need therapy, of a serious sort, now. See a qualified medical professional." The question amounts to chatfilter in its non-specificity and its logorrheic excess. There's no question there, just a massive screen dump of symptomology. Could be NPD, could be Munchausens, could be anxiety disorder, could be a fucking brain tumor for all we know.

There have been much more serious examples of lines being crossed that give me the willies on AskMe.

I personally think the question, and the questioner, are disingenuous at best, delusional (and in need of real help we can't provide) at worst. There's no way to respond to something like that that isn't trivial (relax, get out more, do some yoga, volunteer in your community) or absurdly unjustified (try Xanax, you have narcissistic personality disorder, whatever).

But there's no real debate here over this subject. It's been adjudicated so many times before. My response is generally to try to avoid the mental health questions. Heck, I basically try to avoid AskMe these days. It's become so dominated by relationship and mental health chatfilter questions that it really has lost its utility to some extent in my opinion. It is what it is, and some people love relationship/mentalhealthfilter questions.

The legal risks of lay medical advice (or misguided professional medical advice) on the site are pretty minimal, really, although you could make a federal case out of them in some cases. We're all here voluntarily, there is no representation of objectivity or expertise on a sitewide basis, and most of us live in free countries. This isn't a hospital intake or community clinic.

Again, I agree with you with respect to the occasional question that I think crosses the line into territory where there is risk of harm to the questioner, although I haven't seen one lately like that (but again, i don't follow AskMe questions of the sort very closely). But there's no point getting worked up about it. Flag, move on, hope for the best.
posted by fourcheesemac at 7:16 AM on February 15, 2010 [7 favorites]


I think one of the reasons people ask medical/psych/pharm questions here is to get some sort of starting point for a conversation with a care provider that can be difficult and intimidating. It's ammunition. Maybe the OP will go to the doctor and say, "Well, Xanax?" and the doctor can say "No, and here's why" or "Yeah, that's an option, but" or "Wohoo, here you go!" Whatever, but it's something that can go on the list.
posted by Lyn Never at 7:21 AM on February 15, 2010 [11 favorites]


I wasn't interested in sparking a debate, I was specifically calling out certain posters in the hopes that they will reconsider their input in AskMe. If you don't have clinical training in mental health or training as a medical professional you should not be making diagnoses or recommending psychiatric medications. In fact, you know anyone making these recommendations doesn't have any training, because people who do would never make these kinds of recommendations. But how does a poster, who is possibly mentally ill, make that distinction when the information is stated with authority as if the poster is capable of ably making those determinations?

It's potentially dangerous, it's bad form. Yes, we've done stuff like this before, and yes these things come up again occasionally to reinforce the fact that people shouldn't be doing things like giving legal or medical advice. This is one of those times, I'm sorry, the input in that thread is crazy bad.
posted by The Straightener at 7:22 AM on February 15, 2010 [2 favorites]


I don't think most people who post questions regarding either (a) medicine or (b) law think that they are going to get responses from people who are doctors or lawyers. Usually, these questions take the form of either "I'm thinking about seeing a doctor/lawyer and I need little push", or "I've seen a doctor/lawyer and want to confirmation/elaboration from others in the lay population with the same issue." In either case, AskMe is helpful, and is in no way replacing the professional advice given by a qualified individual.

As someone who has had to deal with anxiety issues, and has sought help from qualified medical professionals in the past, I can attest to the fact that AskMe provides an additional, important tool for the process of gathering information and understanding the nuances of mental health issues. Talking with other's who have the same issues as myself is something I would do anyway: the internet just makes it easier. At the same time, I recognize that what I am getting is lay opinion, not professional advice. I think the tenor of AskMe makes this pretty clear, and I wouldn't want to see it limited.
posted by HabeasCorpus at 7:22 AM on February 15, 2010 [7 favorites]


I was specifically calling out certain posters in the hopes that they will reconsider their input in AskMe.

I'm pretty comfortable with my input, I stand by my answers, and I'm not a guy.
posted by A Terrible Llama at 7:24 AM on February 15, 2010


I basically try to avoid AskMe these days. It's become so dominated by relationship and mental health chatfilter questions that it really has lost its utility to some extent in my opinion.

Huh. You know you can filter your view of AskMe by category, right? Utility out the wazoo.
posted by mediareport at 7:25 AM on February 15, 2010 [3 favorites]


But there's no point getting worked up about it. Flag, move on, hope for the best.

There's a sentiment that no social worker worth their salt will not chafe at, but that's logical enough advice in this instance.
posted by Burhanistan at 7:25 AM on February 15, 2010 [1 favorite]


You know you can filter your view of AskMe by category, right? Utility out the wazoo.

I looked for that last category you mentioned but didn't see it. Is it SFW?
posted by Burhanistan at 7:27 AM on February 15, 2010


If you don't have clinical training in mental health or training as a medical professional you should not be making diagnoses or recommending psychiatric medications

But people do it all the time, and not just online. And if in fact you are a trained professional, you should be even more cautious about not representing yourself as an expert or giving expert or professional advice. If you are clearly not a medical professional (or a lawyer) there really is no ethical problem here unless there is some way your opinion could be misconstrued as more than a lay opinion. That never happens in the thread in question. In fact, you are the only one claiming expertise there, and you've made your expert opinion (which is correct from your professional perspective) abundantly clear, perhaps at greater risk ethically than anyone else in the thread is taking (although not really, since the advice to see a qualified professional immediately and in person is always correct and really all one can say as a professional in such a situation where you do not have either the right or the obligation or the correct setting to practice your profession).

People say "take a Xanax" (or a valium, or a chill pill) all the time in ordinary conversation, metaphorically meaning "calm the fuck down." That is not medical advice. That's free speech.
posted by fourcheesemac at 7:29 AM on February 15, 2010 [4 favorites]


Yeah, I know mediareport. But I like to browse, and I do like some questions in the category, so that won't help. I can usually guess from the question what the conversation will be like and avoid ones that I know I'll add more heat than light to. Not so much negative utility as less focused, I guess is what I mean. I used to learn more from reading AskMe than I do these days.
posted by fourcheesemac at 7:31 AM on February 15, 2010


this site has lost at least one medical professional who was a respected member over this very issue as well

With all due respect, that was a small part of a larger problem that member had on this site.
posted by jessamyn (temp) at 7:32 AM on February 15, 2010 [6 favorites]


Yes, fair enough. But he could never let this issue go.
posted by fourcheesemac at 7:32 AM on February 15, 2010


There is far more dangerous advice being given on AskMe on a semi-regular basis. People have actually recommended using a gun to scare off a stalker, which no person in their right mind would consider good advice. Yet, there it is. Implicit in the AskMe social contract is that you are able to understand that much of the advice being given is just terrible as all get out. If only good advice were allowed to be posted, we'd need another fifty mods, all of whom were experts in their field. Not going to happen.

I like you, TS, and respect your wisdom, but your best bet is to a) email the mods when genuinely dangerous advice is given and b) post in the thread recommending the asker not follow that advice.
posted by Optimus Chyme at 7:33 AM on February 15, 2010 [3 favorites]


TheStraightener,

I think you have to recognize a difference between prescribing medication, and talking about what effects/benefits/drawbacks a medication has had for you in the past. Its almost absurd to suggest that no-one talk about medication. Hearing other people's suggestions and conclusions about medications they've tried is an important part of the process of informing yourself about medications that doctors proscribe. I sure as shit want to hear about what other people are taking, and how it effects them, when I'm deciding to take a drug regime myself. Keeping myself in the dark by refusing to even listen to non-professionals seems, well, silly. A Terrible Llama's advice was clearly in the second category.
posted by HabeasCorpus at 7:34 AM on February 15, 2010 [4 favorites]


There is no reason any Mefite should be recommending that any other Mefite take a medication under any circumstances whatsoever.

I am not a doctor but I am a Type II Diabetic and have recommended or suggested certain medications for dealing with that disease and will continue to do so in the future. Considering that I can't actually dispense the meds or write a prescription, it's probably ok if OP takes the suggestions to the their doctor to discuss that.

I've also suggested exercise and better eating habits, is that ok?
posted by Brandon Blatcher at 7:36 AM on February 15, 2010 [6 favorites]


I can attest to the fact that AskMe provides an additional, important tool for the process of gathering information and understanding the nuances of mental health issues.

The worst kind of mental health practice which the profession has struggled for long time to discontinue is to slap a diagnostic label on someone, which may not even be reliable, and send them out the door. We don't just tell people, "you have anxiety disorder." Or, "you're schizophrenic," and just medicate them like a pill is the answer and a mental health disorder is treatable in the same way as other health conditions because they are not. A person is not their diagnosis, they are people, and reducing someone to a diagnosis is per the input of thousands of mental health consumers over the decades more damaging than helpful. I'm sorry, maybe I should have qualified a little better why this type of behavior in AskMe bothers me, but, "You have X, you should take medication Y" pretty much captures everything bad about mental health practice and yes it bugs me because the people making these statements, who think they know something about mental health practice, haven't even taken the time to educate themselves to the mental health recovery model that guides client-centered, not clinician-centered, treatment.

It would be a big difference if the thread was guided by the input of people in the community with anxiety disorders who were sharing their own experience with the poster in the hopes that perhaps some identification with that could provide some insight, clarity and maybe some motivation towards recovery and symptom management. The input I highlighted is not peer-focused, it is pretend clinician-centered mental health.
posted by The Straightener at 7:39 AM on February 15, 2010 [12 favorites]


I've also suggested exercise and better eating habits, is that ok?

I overreacted and could have phrased things better but your being a dick about it is not particularly constructive, either.
posted by The Straightener at 7:45 AM on February 15, 2010 [1 favorite]


I wanted to be a psychiatrist but I suck a geography.
posted by cjorgensen at 7:47 AM on February 15, 2010


I don't think most people who post questions regarding either (a) medicine or (b) law think that they are going to get responses from people who are doctors or lawyers.

I think that's true, but inaccurate. People might not expect to get definitive answers from doctors/lawyers—but they do expect definitive answers. The mechanism, oversimplified, is that people believe there are "definitive answers" to their questions, and that the major difference between getting those answers from a professional versus a layperson is a bill.

That's an issue that runs deeper than AskMe. But the point is: We do encourage people to treat AskMe as a place to find definitive answers. The mods do. Isn't the basic guideline that posters must have a question to be answered or a problem to be solved? And this is what could be great about AskMe—in a community of thousands, there's bound to be a couple people who know the answer to my question. So what does "polling the hive mind" look like? Is it 30 responses from people who post in dozens of threads in a day, or two responses from people who only speak when they know what they're talking about?
posted by cribcage at 7:57 AM on February 15, 2010 [4 favorites]


The worst kind of mental health practice which the profession has struggled for long time to discontinue is to slap a diagnostic label on someone, which may not even be reliable, and send them out the door. We don't just tell people, "you have anxiety disorder." Or, "you're schizophrenic," and just medicate them like a pill is the answer and a mental health disorder is treatable in the same way as other health conditions because they are not. A person is not their diagnosis, they are people, and reducing someone to a diagnosis is per the input of thousands of mental health consumers over the decades more damaging than helpful.

But like you said before, we're not doctors, and nobody is pretending to be doctors, so doesn't this not apply? In all of these threads are numerous comments telling the op to go see a medical professional, so I don't see how we're in any way perpetuating the problem that is a part of your profession.
posted by kylej at 7:59 AM on February 15, 2010


Given the billions of dollars spent every year to push the message "Ask your doctor about Obecalp" it seems a little disproportionate to be this upset about an AskMe thread where people make suggestions they actually believe in.
posted by Horace Rumpole at 8:03 AM on February 15, 2010 [12 favorites]


I understand where you're coming from, but I have to disagree with you. Others have stated the implication that none of the people answering are doctors unless specifically noted. There may be someone reading the OP's question that could answer with "hey, I know exactly what you're going through, and here's what helped me: X, Y, and Z, with a daily dose of exercise". Z could be a prescription medication. I think there is a large logical gap between "this helped me, do some research and ask your doctor whether or not they think it could help you" and "holy shit, Xanax??? where can I get it??? do my friends have any??? I'm taking ten!!!".

I still don't think that information presented in AskMe mental health threads is "posted with authority", especially if it is one person's account of how a medication helped them. If you are saying that this kind of advice should be specifically blocked because people with mental illnesses can't tell the difference, well that seems a bit insulting.
posted by amicamentis at 8:06 AM on February 15, 2010 [1 favorite]


I overreacted and could have phrased things better but your being a dick about it is not particularly constructive, either.

Apologies, I actually am trying to be constructive here.

If you're think members shouldn't be recommending medication, then what, in your opinion, is the line for health recommendations, be it physical or mental? After all, in the example I gave, a person won't know a person's actual health, so recommending changing food habits or exercise might not be a good idea.

If a person asks for suggestions on healthy snacks and someone suggests nuts, do we worry about if the person is allergic to nuts? No, we assume that if the OP gets that suggestion, they probably won't eat the nuts.

Yeah, this is beyond the narrow scope of your concern, but in the larger picture it matters and is worth bringing up. There have been several questions concerning pysche drugs and weight gain and people who have been on psyche drugs have chimed in with various answers about what did and didn't work for them. Isn't that more helpful than not answering? At some point, doesn't OP have to take the suggestions and consider whether to talk them over with their doctor?
posted by Brandon Blatcher at 8:08 AM on February 15, 2010 [2 favorites]


Given the billions of dollars spent every year to push the message "Ask your doctor about Obecalp" it seems a little disproportionate to be this upset about an AskMe thread

I don't disagree with you in a broad sense, but at the same time that kind of equivalency making can simply paralyze any kind of attempts of site introspection or possible avenues of improvement in response to touchy subjects.
posted by Burhanistan at 8:09 AM on February 15, 2010


We do encourage people to treat AskMe as a place to find definitive answers. The mods do. Isn't the basic guideline that posters must have a question to be answered or a problem to be solved?

I think the analogy you're making is a little off. Posters have to have a problem or a question. They are aware that when they ask it here, they are asking a large assortment of people many of whom will only be offering their own opinions or advice, some of whom may also be experts, most of whom aren't. We don't in any way forward the idea that most people will get anything approaching a definitive answer to their question. Some will, most won't. Most questions don't have a definitive answer anyhow. Our hope is that people will get more information that will help them answer their own questions.

We do not want AskMe to turn into a "only answer if you have specific advice that will definitively solve the OPs problem" area. However, the flip side of this is that sometimes people talk out of their ass. Or sometimes people show up asking questions that require very specific medical or legal or refrigerator repair advice, and those questions often don't go well [unless Mitheral is around]. I find that the community is usually pretty good at telling people when the problem they have requires the OP to leave AskMe and go elsewhere and speak to a trained professional to get an answer. The line where this is drawn unfortunately often falls somewhere outside the comfort zone for trained professionals.
posted by jessamyn (temp) at 8:09 AM on February 15, 2010 [1 favorite]


The mechanism, oversimplified, is that people believe there are "definitive answers" to their questions,

This is true, but to my mind there's an implicit understanding that the 'definitive answer' isn't necessarily a definitive diagnosis. The definitive answer might be 'see a doctor', or 'your next step is to break up with your girlfriend' or 'has your mechanic looked at your exhaust system?' or whatever.

I don't think the idea is that the hive mind can diagnose your mental health disorder or provide investment advice, but that you could walk out with a next step--a direction to go in, when someone is at a crossroads. So it's less a definitive answer than potential avenues to pursue.

Some questions have real, concrete answers. I'm considering asking what I'm supposed to do with the green peppercorns I bought on impulse. I can get concrete answers on that. But some are just muddled questions and those are the ones that get answers that are like "maybe try X" which pisses some people off.

Also, if anyone knows what I'm supposed to do with the peppercorns, feel free to tell me.
posted by A Terrible Llama at 8:10 AM on February 15, 2010 [1 favorite]


People suggest a lot of ignorant voodoo and perpetuate bad folk wisdom and misinformation in my field, too. I'm fortunate that in most cases lives are not at stake in my field, however I do very much sympathize with the frustration of seeing ignorant laypersons give pointless, bad, or dangerously stupid advice over and over again. The internet is chock full of wrongness, and it'd be really nice if there were some kind of Wedgie-over-IP protocol that you could apply to people who go around intentionally misleading others with their stupidity.

That having been said, I fully support the right of ignorant people to make ignorant statements. I even support their right to taking a misguidedly confident tone while doing so. Free country, after all. It would be nice if people could refrain from spouting misguidance like that, and I wish they would for the sake of Ask Metafilter quality if nothing else.

But the answer to misinformation is to use the contact form, specify the comment that is dangerously bad and that someone will be harmed as a result. Our moderation team seems to be pretty big on keeping folks from being harmed if it's within their power to do so, and has demonstrated consistent good judgement in matters of moderation.

If the misinformation isn't hazardous, but just gives you facepalm-related fatigue, I'm sorry, but the right of others to be wrong on the Internet trumps your right to a high quality Ask Metafilter experience. I don't like that this is true. I wish it were not true. It is, however, true.
posted by majick at 8:17 AM on February 15, 2010 [5 favorites]


I overreacted and could have phrased things better but your being a dick about it is not particularly constructive, either.

I think you've mistaken your dick for his.
posted by five fresh fish at 8:18 AM on February 15, 2010 [2 favorites]


I've also suggested exercise and better eating habits, is that ok?

Oh hell no. Immediate progress in pill form or GTFO.
posted by BitterOldPunk at 8:21 AM on February 15, 2010 [2 favorites]


I don't think most people who post questions regarding either (a) medicine or (b) law think that they are going to get responses from people who are doctors or lawyers.

One contributor in the thread clearly states, "I am a psychologist" after having outlined what he or she thinks might benefit the poster in terms of treatment were the poster his or her client. This is seriously dicey. The problem ikkyu2 ran into as an AskMe contributor was he openly established his authority as a real life medical professional, and it became very complicated when a mentally ill contributor formed a relationship with him that was in my opinion rather questionable because ikkyu2 it seemed was at times her friend, at times her doctor privately making treatment recommendations based on information she was providing online. Reading back through Garden's history it is clear that there is a mental health issue of some kind at hand, though it is impossible to determine from what is presented what the issue might be or if the information presented is even truthful or accurate. There is no therapeutic benefit to be had from establishing even the appearance a clinical relationship with a person like this over the Internet. There is only further confusion to be had on Garden's behalf, because now Garden's real life therapist's clinical relationship is being called into question by another real life professional online who is recommending a different course of treatment.

Having actual health and mental professionals on AskMe stating their credentials and making recommendations totally happened in the past, happened in this thread, and poses a much greater potential danger than potential help to the person on the other side of the interaction who may be confused, who may be delusional and is already engaged with a professional in real life and doesn't need that relationship complicated by another professional's contradicting input from the distanced perspective of a cursory online interaction.
posted by The Straightener at 8:28 AM on February 15, 2010 [3 favorites]


The Straightener, as far as your concern about labeling and diagnosis goes and the history of bad practice and difficulty of practice that has made for mental health counselors goes, I simply wish to say that it is looking more and more like the DSM-V coming out in 2012 will help to alleviate a lot of that. I'm sure as a professional you've noted the trend in shifting from, "You have X disorder. Here is Y treatment. Run along now," to "You have SYMPTOMS of X disorder. Let's try Y treatment and see where we go from there. We may have to adjust to Z treatment for a bit, or we may wish to consider a combination of Y and Z treatment for you," to, "You have SYMPTOMS of THIS SEVERITY of X DISORDER. We know that Y treatment works in people with this disorder, but usually those cases are of a DIFFERENT SEVERITY and may not work for you. Let's go with something more along the lines of TREATMENT A before jumping to TREATMENT Y."

For things like schizophrenia, this may be less helpful. But for something like General Anxiety Disorder, this new way of thinking can go a long way.

My point is, though it be slow, we are beginning to move away from labels as the catch-all-be-all aspect of treatment and we are beginning to look more and more at symptoms without attributing labels when we can. I imagine this shift of thinking will eventually trickle down into the world much in the way the names of disorders have.
posted by zizzle at 8:29 AM on February 15, 2010


I think the notion that everything is simply "a suggestion" in AskMe, and therefore is just fine, is a bit of a cop out.

I agree with The Straightener, there is a huge amount of mental health bullshit passing for answers on AskMe, and much of it is not only incorrect, but potentially harmful. In mental health questions, consensus often quickly forms, but it's uninformed and incorrect consensus. People who are coming to AskMe for support, or for confirmation, will likely have a very hard time separating the good advice from the bad, especially if the bad advice echoes their own prejudices. Mental health problems are frequently very resistant to re-definition once the patient has bought into a particular way of looking at the problem. I'd go further than The Straightener and say that not only do we try to avoid just slapping on a diagnosis, but we frequently have to try to convince people not to diagnose themselves.

I think the important consideration here is not between something that is "permitted" or not, but whether something meets the ethical norm we would like to see in AskMe. That's why I think this appeal to an idealized conversation, in which everything is simply a suggestion that someone should follow up with detailed consultations with multiple doctors, hopefully in several different specialties, is a cop out. It might make people sleep better at night, but I think glib diagnoses aren't really part of that kind of conversation, nor is the glib suggestion to try highly addictive medication. I wish that the conversation about these issues was less about whether or not people have the inalienable right to diagnose and prescribe, and more about whether or not it's a good idea.

That thread is a trainwreck.
posted by OmieWise at 8:30 AM on February 15, 2010 [12 favorites]


Thank you, OmieWise, I was hoping you would show up.
posted by The Straightener at 8:34 AM on February 15, 2010


I simply wish to say that it is looking more and more like the DSM-V coming out in 2012 will help to alleviate a lot of that.

No it won't. People don't bother to pay attention to the DSM guidelines for the particular malady they're busy diagnosing on AskMe. They just have a vague notion of what the disorder entails and they capitalize the name and push on through. No revision to the diagnostic framework (which, let's face it, sucks now and will continue to suck under V) is going to change that.

I recall a great thread where someone was diagnosed with PTSD for something that had happened to them a few days before, and when ikkyu2 pointed out that this was inane given the diagnostic criteria, people acted like he was the one who was ignorant.
posted by OmieWise at 8:35 AM on February 15, 2010 [3 favorites]


You're just reading those comments wrong.

You need to be mentally adjusting them to, "Ask your doctor if ____________ is right for you."

Because, hey, you know what? IT'S PRESCRIPTION MEDICATION. Presumably, the OP would be consulting a doctor about it if you're going to be taking it. When someone comments, "Hey, I have a bunch of extra Xanax you can take off my hands," then you can get worried.

Additionally, as usual, there is a lot of conflicting advice in that thread for the OP to sort out. How do you suppose the OP will go about that? My money is on consults a physician.

Also, The Straightener, you seem pretty anxious. A course of Effexor should clear that right up.
posted by Sys Rq at 8:39 AM on February 15, 2010 [4 favorites]


you're (s)he's
posted by Sys Rq at 8:39 AM on February 15, 2010


Taking a short acting benzo for GAD is horrible advice. Getting benzos from a GP for an ongoing problem is horrible advice. Telling someone suffering from anxiety that they might have NPD (did you miss the part where the poster thought they were stupid?) is a stupid thing to say.
In general the advice here is a lot better, and I do think it's valuable. I think that we all (including me) should make an effort to speak from our own experiences in these questions, and avoid super-confident YOU HAVE THIS DUH kinds of things that are beyond our scope of knowledge.

Oh and it should be fucking illegal to suggest that someone has a personality disorder unless you're eqipped to support them through the crushing depression that can resullt from being told that you have something is incredibly stigmatized and seen as incurable. It's the mental health equivalent of being told "hey, seems like you have stage 4 ovarian cancer! Just a guess! :)"
posted by kathrineg at 8:41 AM on February 15, 2010 [4 favorites]


Oh yeah I'm not a shrink, so maybe that was great advice and all the best shrinks are throwing xanax at maybe-GAD and diagnosing people by throwing darts at old issues of Psychology Today.
posted by kathrineg at 8:47 AM on February 15, 2010 [2 favorites]


I recall a great thread where someone was diagnosed with PTSD for something that had happened to them a few days before, and when ikkyu2 pointed out that this was inane given the diagnostic criteria, people acted like he was the one who was ignorant.

*cough*

Post Traumatic Stress Disorder is not something that you would have until well after a traumatic event. Acute Traumatic Stress Disorder can be present directly after a traumatic event and may or may not develop into Post Traumatic Stress Disorder, which is chronic and ongoing. I'm not trying to be a dick, but it's not a good idea to recommend that someone may be suffering from a disorder if you don't know what the basic criteria for that disorder is."

That was two weeks ago.
posted by The Straightener at 8:52 AM on February 15, 2010


Sys Rq, not sure what experience you have with the quality of mental health care provided by GPs but if someone goes to their family doctor s/he will not necessarily prescribe xanax in a responsible way. "Ask a doctor, preferably a psychiatrist, about xanax" is one thing, "take a xanax you never know it might help" is another thing entirely.

Of course I am guilty of constantly suggesting adderall because in my experience, and the experience of my friends it's life-changing and relatively easy to stop taking. I still should be careful about it so thanks for reminding me of that, The Straighter.
posted by kathrineg at 9:03 AM on February 15, 2010 [1 favorite]


Because, hey, you know what? IT'S PRESCRIPTION MEDICATION. Presumably, the OP would be consulting a doctor about it if you're going to be taking it.

This is what I'm talking about when I call this kind of reasoning a cop out. Just because something's a prescription medication does not mean that one needs a prescription to obtain it. But the moral reasoning that trumpets the need for a doctor's intervention to follow through on the Askme answer ignores the real world in which drugs are widely available illegally and that, in this case, Xanax is a widely used drug of abuse. Further, it ignores the fact that doctors are much more likely to prescribe a given medication and issue a given diagnosis if you get your patter down about it before ever going to see them.

If one wants to prescribe in AskMe then one should at least acknowledge that there may be no gatekeeper, or even just a very busy and rushed gatekeeper, between one's prescription and the medication.

(Actually, I think it was this comment from ikkyu2 that I was thinking of, I had missed that newer thread as I've kind of been avoiding mental health AskMes.)
posted by OmieWise at 9:05 AM on February 15, 2010 [1 favorite]


TS, do you have any practical suggestions regarding how to address this?

I'm not trying to be snarky or combative, as I agree with much of what you have to say. In fact, in some ways I would go much further than you. Many medical threads are of questionable usefulness, precisely because individuals (amateur and professional) make recommendations on far too little information. Askers will summarize a few symptoms, and responses will run the gamut from "that's nothing at all, happened to me once and I got better after a few days - don't worry" to "OMG my aunt had those symptoms and it turned out she had terminal cancer - got to a doctor RIGHT AWAY!" If you ask a population of 90K to comment on some symptoms, its not unlikely that you will get a broad range of opinions and experiences, which leads to a broad range of advice - good, bad, and dangerous.

But I just don't see how to completely prevent the dangerous advice without outright banning all medical questions (not just mental health ones). This is a question of risk vs. benefit: do the benefits (helping askers relieve their suffering) outweight the risks (potentially dangerous advice that may increase their suffering)? So far, the community has answered a resounding "yes." The upside is that some people are genuinely helped - indeed, its probable that some of those amateur diagnoses and recommendations are, through sheer random variation, correct (maybe Xanax is exactly what the asker needs). The downside is that some people may receive, and follow, poor or dangerous advice.
posted by googly at 9:08 AM on February 15, 2010


And, to the larger issue, I agree that we should have some decent terms of service about medical/legal questions generally. CrazyMeds [which comes up a lot when people start talking about medication for various mental illnesses and other issues] has this on their sidebar. I'm not sure it's helpful and I'd be really curious what legal or bigtime ethical issues they've expereinced.
All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won't necessarily happen to you. Nobody on this site is a doctor, therapist, or a pharmacist. We don't portray them either here or on TV. Only doctors can diagnose and treat an illness. Some doctors tend to get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don't be a cyberchondriac, thinking you have every disease you see a website about, or that you'll get every side effect from every medication. Self-prescribing is just as dangerous. All information on this site has been obtained through personal experience, the experiences of my friends, the experiences of people reported on online support groups, and from sources that are referenced throughout the site. Know your sources! As such the information presented here is not a substitute for real medical advice from your real doctor, just a compliment to it. No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. All brand names of the drugs listed in this site are the trademarks of the companies listed after them in the pages about the drugs, even though those companies may or may not have been acquired by other companies who may or may not be listed in this site by the time you read this. Always read the PI sheet that comes with your medications and never ever throw them away. If you didn't get a PI sheet, demand one. Loudly. Crazy Meds is not responsible for the content of sites we provide links to. We like them, or they're paid advertisements, or they're something you should read to make an informed decision about a particular med. Sometimes they're more than one of those things. But what's on those sites is their business, not ours. Very little information about visitors to this site is collected or saved. And from time to time I do look at search terms used to find it in an effort to make the information I present more relevant. Use only as directed. Void where prohibited.
posted by jessamyn (temp) at 9:09 AM on February 15, 2010 [2 favorites]


Taking a short acting benzo for GAD is horrible advice.

If by "horrible advice" you mean "common, typical, and often very helpful" then you're right!

Getting benzos from a GP for an ongoing problem is horrible advice.

Well, you palmed a card a little bit here by saying "GP". I agree that a GP is not in the best position for something like this. Was someone recommending this?

Anyway, I mentioned the word "Xanax" in my answer and I didn't get called out by the Straightener. So I'm disappointed. I've never been called out. What do I have to do?

Also, I just dropped my cat off to get a biopsy on a giant freaking tumor in his throat. The biopsy is just a formality, he'll have to be euthanized soon. So I could really use a benzo.
posted by Justinian at 9:10 AM on February 15, 2010 [2 favorites]


(Instead I am being comforted by my good buddies, Jack and Jim)
posted by Justinian at 9:13 AM on February 15, 2010


I find that the community is usually pretty good at telling people when the problem they have requires the OP to leave AskMe and go elsewhere and speak to a trained professional to get an answer.

This.

You need to be mentally adjusting them to, "Ask your doctor if ____________ is right for you."


Also this. Sys Rq, imo, sort of hit the nail on the head. Despite the fact that the OP couldn't get any sort of meds without consulting an actual doctor first (did you forget about that?), the unspoken sentiment with regard to these sorts of questions is, "here is some information so you are informed when you go see your doctor/lawyer/whatever. Here is my experience, so here are some questions you might want to ask them." And that can be powerful advice.

I agree with you, and certainly the way a lot of folks posit this sort of advice is more than a little tenuous, and this thread is an apotheosis in this regard.

As a mental health professional who will be backed up on this by other mental health and medical professionals on this site

I mean, no one is completely disagreeing with you here man, but you come off sounding more than a wee bit childish in that, "i know about this and you don't. na na na na na na. So there!" Chill-out man; it's the internet.
posted by Lutoslawski at 9:18 AM on February 15, 2010 [2 favorites]


Also, I just dropped my cat off to get a biopsy on a giant freaking tumor in his throat. The biopsy is just a formality, he'll have to be euthanized soon

Justinian - if this is true, I'm really sorry man. That sucks.
posted by Lutoslawski at 9:19 AM on February 15, 2010 [3 favorites]


I agree that a GP is not in the best position for something like this. Was someone recommending this?

Yeah, that was me. My GP writes my Xanax prescriptions. He doesn't seem to think it's weird. I keep a standing Ambien prescription and a standing Xanax prescription. I don't go through them like they're M&Ms or anything, but I've found them useful to have around. Especially Xanax, if for no other reason than it mitigates the quaking fear surrounding my overly frequent trips to the dentist.
posted by A Terrible Llama at 9:19 AM on February 15, 2010


Also, I just dropped my cat off to get a biopsy on a giant freaking tumor in his throat. The biopsy is just a formality, he'll have to be euthanized soon


Justinian - if this is true, I'm really sorry man. That sucks.

Me too Justinian.
posted by A Terrible Llama at 9:21 AM on February 15, 2010


Just because something's a prescription medication does not mean that one needs a prescription to obtain it.

Ok, sure. But in general AskMe is good about telling people to seek professional help. I don't think any of the contentious responses were suggesting that the OP just go pick up some black market psych meds.
posted by Lutoslawski at 9:24 AM on February 15, 2010


AskMe is this weird line-blur between expert and non-expert advice on virtually every topic and, as a result, should come with a disclaimer. I would, off the top of my head, suggest that when you categorize your question into one of the potentially dangerous categories, you get a Mail or a screen in between which basically tells you to take what you get with a grain of salt and that the advice you get doesn't replace that of a professional?

That way, every poster is warned that there's no restriction to who gives seemingly expert advice and that no matter how convincing an argument they may make, they're not a substitution for a professional. It's attacking it from poster-side, which seems easier than from the commenter-side.
posted by Hiker at 9:25 AM on February 15, 2010


I think part of the problem with the expert-knowledge version of mental health is that potentially any piece of advice on personal issues has mental health implications. We're not allowed to help each other make sense of our lived experience anymore, and I hate that. The problem here isn't unjustified appeals to authority by laypersons... the problem is unjustified appeals to authority by experts!

Psychiatry is not nearly as evidence-based a discipline as it frequently lets on, as is often demonstrated by MeFi's own The Last Psychiatrist. We're mostly all just muddling through, and the people we should blame for diagnosis taxonomies are in the psychiatric community, and they (not The Straightener, but the psychiatrists with MDs who do the prescribing) do quite a lot of this unprincipled definition themselves, slapping diagnoses on folks after a couple of sessions that follow them around for the rest of their lives. That we're now being chastised for trying to take up the master's tools in order to spruce up the master's house is, well, galling.

Of course, we'd often be better off if we just forwent the medical jargon entirely, and I think that's The Straightener's point. But we live in a heavily medicalized world, where most problems can be articulated (and many are probably best articulated) as some kind of pathology or syndrome, so it's not surprising (or unethical) that laypeople would start trying to understand their situation in these terms.
posted by anotherpanacea at 9:26 AM on February 15, 2010 [9 favorites]


Just because something's a prescription medication does not mean that one needs a prescription to obtain it.

I don't think we can be expected to base our answers on the possibility that people might take those answers and use them in an illegal, dangerous, and unwise fashion. We'd all be reduced to using AskMe for nothing but "WHAT SHOULD I NAME MY NEW HAMSTER LOL!LLL".
posted by Justinian at 9:30 AM on February 15, 2010


As such the information presented here is not a substitute for real medical advice from your real doctor, just a compliment to it.

Typo, or subtle jab at the forum's posters?
posted by DevilsAdvocate at 9:30 AM on February 15, 2010


TS, do you have any practical suggestions regarding how to address this?

I do, but it's not really the answer I think a lot of community members want. That is to restrict one's input on mental health related questions to one's own experience with whatever disorders you personally may have dealth with. Don't diagnose, because accurate diagnoses cannot be made online even by qualified professionals. Don't suggest medications, because that can be dangerous without knowing what other medications someone may be taking, what street drugs they may use that could have toxic interactions with psychotropics or what allergies they may have. If you are a mental health or health professional, please check your motivations before contributing to a question in your area of expertise. Are you primarily contributing because you get to show off you knowledge and clinical abilities to the community? Are you creating a conflict between your online authority as a real life professional and someone's current, real life treating professional?

You can comb through my history on this and find that I am not asking anyone to do anything I don't do myself. The only thing I have ever done in any thread on mental health or addiction related issues is explain to people how to navigate the often complicated systems that can yield valuable resources to them such as treatment, welfare, disability, housing, etc. That knowledge I do have and I do want to share, because I have had numerous, numerous people contact me privately either to tell me what I shared helped them access the services they needed or to ask for further instructions that then resulted in accessing services. My only goal of my online contributions is to get the person in front of the real life professional who can treat them. I do not attempt to treat or recommend courses of treatment online because that doesn't work, at least I don't know of any study that says it does. I am constantly checking my motivations in responding to these threads to ensure that I do not overstep the admittedly narrow area of my own expertise. I am a social worker, not a psychologist, not a psychiatrist, not a doctor. I try to be good at what I am not try to be a bunch of other things I am not.

This is not a lot to ask, in fact to me it's just common sense. The community has gotten better at it with respect to legal and medical issues but is seriously struggling with mental health. Please, seriously. Try harder, this is really important and not just to me personally.
posted by The Straightener at 9:31 AM on February 15, 2010 [12 favorites]


If one wants to prescribe in AskMe then one should at least acknowledge that there may be no gatekeeper, or even just a very busy and rushed gatekeeper, between one's prescription and the medication.

But Omiewise, that cuts both ways. The very busy and rushed gatekeeper could well be missing aspects of the patient's disorder, aspects about which the patient may do well to be educated. This kind of education can take place in personal discussion with friends or on internet message boards. All that's happening in either case is conversation. And the conversation may well end up highlighting symptoms that have gone unnoticed or diagnoses that should be considered.

If the professional is too busy and rushed to be trusted as a gatekeeper, then why the implicit trust that he/she would have given comprehensive consideration to the case in the first place and can be trusted with a diagnosis?

And anyway, isn't every health care professional these days used to hearing "I looked up my symptoms on the internet, and here's what I think I have"? If Garden's doctor can't handle a discussion of that kind, then Garden needs to find a new doctor.
posted by torticat at 9:32 AM on February 15, 2010 [1 favorite]


"All rights reserved. No warranty is expressed or implied in this information ... Use only as directed. Void where prohibited. Dilute! Dilute!"

posted by octobersurprise at 9:32 AM on February 15, 2010 [1 favorite]


You all seem really stressed out. As a mental health professional (tech support supervisor, but really, it's the same thing, right?) I would normally strongly suggest a prescription course of kittens and alcohol.

However, in light of what has been pointed out in this thread, I'm willing to concede that just making blanket medication suggestions might not be in the best interests of the readership, so I'll offer an alternative for those inclined to seek one;

Pot and puppies.

Trust me. I'm like a doctor.
posted by quin at 9:33 AM on February 15, 2010 [4 favorites]


We don't in any way forward the idea that most people will get anything approaching a definitive answer to their question. Some will, most won't. Most questions don't have a definitive answer anyhow. Our hope is that people will get more information that will help them answer their own questions.

Exactly. That there's a conflict between the basic functionality of Ask (people who are members of the community here are welcome to try and help provide answers to other folks' questions) and some of the situations where the gap between lay knowledge and professional expertise is stark and kind of ethically fraught, and I don't think there's really any satisfactory, non-destructive approach to significantly reducing that friction. Encouraging people to be explicit about the context of their answers and their (lack of) specific formal experience seems like the best route, and I feel like most of the time that can be done pretty well in a thread if folks keep it civil.

This is not a problem that is contained to or specific to Ask Metafilter. I'm not repeating that as a dodge; the point is there is a systemic issue with how folks communicate in general in the world, with how folks seek and provide advice in every walk of life, that's at the root of the friction between lay and expert opinion; there's not some switch we can throw on askme that will make it not happen here.

We don't intend to forbid people to ask about, or try to answer questions about, legal or medical or mental health issues in general, and we're frankly not equipped to try to enumerate or finely adjudicate some sort of bright-line rule about which can and can't be asked or what answers can and can't be given. Shutting down the whole range of topics would be a big disservice to the majority of folks who aren't in unusually vulnerable places re: those questions, and with the troubling outlier stuff I think the best we can hope for is (a) folks with expertise about that vulnerability offering what help they feel they can in terms of in-thread guidance or contact form communication and (b) folks in general to try and be clear about where their answers are coming from and avoiding any undue strident or authoritative framing on what are really just experiential/anecdotal reports.

This is not a lot to ask, in fact to me it's just common sense.

TS, I don't really disagree with you there and I think that's actually a pretty good summation of how people can do better with this stuff. There's the broad problem of going from that point to actually getting a large, diverse base of people with varyingly limited attentiveness to any set of rules or guidelines to digest and apply that kind of reasoning, and I'm not sure immediately what methods would be practical and desirable for trying to improve things on that front.
posted by cortex (staff) at 9:40 AM on February 15, 2010 [1 favorite]


> resist your urge to be helpful to the poster if the only thing you have to contribute is a diagnosis or medication recommendation you are not qualified to make.

Noted. Absolutely. I like to think when I talk about mental health treatments, it's exclusively from a "what works for me is x,y,z. Maybe look into those," standpoint. But I'll be more careful not to slip into casual and accidental outright referral.

Also, re: the benzos for GAD, ehhhhh GAD sure does occur WITH panic attacks often enough to be confusing. Heh. ikkyu2 is an IRL pal of mine, and he told me it's better for me just to have a cocktail to chill out than to take xanax. So I like so say (in classic abusive use of advice AskMe fashion) "I'm not self-medicating, there was a doctor involved!"
posted by Ambrosia Voyeur at 9:49 AM on February 15, 2010 [1 favorite]


Oh, and I am sorry for starting this off so poorly, that was my fault, I apologize for that and I will take deep breaths before my next MetaTalk.
posted by The Straightener at 9:50 AM on February 15, 2010


The conversation seems to have moved on from this, but I still want to say the following.

The sense of superiority underlying some of the statements in this conversation is, frankly, disgusting. Two glaring examples:

The mechanism, oversimplified, is that people believe there are "definitive answers" to their questions

People who are coming to AskMe for support, or for confirmation, will likely have a very hard time separating the good advice from the bad

I'm appalled by this we and them thinking. We know that there are no definitive answers, but they don't. We can separate good advice from bad, but they can't. What can we possibly be basing our assumption that we're more intelligent and discriminating than "people" on? These "people" are community members just like us. Let's get a grip.
posted by kitcat at 9:55 AM on February 15, 2010 [1 favorite]


All that's happening in either case is conversation. And the conversation may well end up highlighting symptoms that have gone unnoticed or diagnoses that should be considered.

Having read this, and anotherpanacea's contribution, and The Straightener's suggestion, and having reread my own answer, I want to clarify that I really do think support extended conversation and discussion about mental health issues. My beefs are with diagnosis and prescription. I have the same beefs in the mental health settings in which I work, so it's no surprise that I also have them for AskMe. Basically, my position is that when the discussions in AskMe include uninformed diagnostic and prescriptive suggestions the conversation become less useful and potentially more dangerous for the questioner.

There are all kinds of problems with our diagnostic nosologies for mental health, and certainly the DSM is neither valid nor reliable. But, I understand that it's the language of the doctor's office, and as such, sometimes people need help parsing it. However, when discussions of general mental health issues get reduced to diagnosis, I would argue that they become more restrictive and less useful. Further, I think that people who throw around diagnoses, and this happens with other issues fraught with emotional power, too, like rape, seem to think that there is no harm in "correctly" naming something. But, I've had a lot of experience treating people who cannot get past whatever it is they feel that their diagnosis is, by which I mean, even when the diagnosis clearly does not apply they have integrated it so fully into their self-conception that change for them is very hard. In general I believe that the more conversation we have about these issues, the better, but I think that there's (in some cases) almost a kind of speech act involved in using diagnostic or prescriptive language for mental health issues, and that uninformed use of that language does more harm than good.

I think that a different set of considerations apply when someone comes into AskMe and says that they've received a diagnosis of X and would like help understanding or challenging or accepting that.

I don't think we can be expected to base our answers on the possibility that people might take those answers and use them in an illegal, dangerous, and unwise fashion.

Then what's the basis for your answer? I mean, what's the moral basis on which you make recommendations of specific medications, that also happen to be drugs of abuse, knowing that they are sometimes (often?) obtained illegally? These suggestions aren't couched like Erowid stories, they're couched as suggestions for use.

and we're frankly not equipped to try to enumerate or finely adjudicate some sort of bright-line rule about which can and can't be asked or what answers can and can't be given.

I'm not sure why the only options are legislative. Isn't articulating a community norm an acceptable compromise?
posted by OmieWise at 9:56 AM on February 15, 2010 [1 favorite]


I don't know what authority he feels he has to make this recommendation, which, in my opinion, is a dangerous recommendation to make, especially considering that he did not educate the poster to the high risk of overdose when taking benzos in combination with alcohol.

Doesn't he have to actually get this from a doctor who does know what he's doing, and will also warn him of the dangers of mixing with alcohol? I think the system has built in barriers to prevent the kind of harm you imagine happening here. This is probably true of every case in which someone recommends a prescribed drug, actually.

Practically, A Terrible Llama's advice boils down to using the suggestion as a place for discussion with one's doctor. I'm not sure how it could play out otherwise, unless one was planning to buy stuff over the boarder. But honestly, there's a greater responsibility on OP's to avoid these kinds of illegal things, and to take every suggestion here as anecdotal or contemplative, rather than professional, than for us to police everything that is said here.
posted by SpacemanStix at 10:00 AM on February 15, 2010


I'm not sure why the only options are legislative. Isn't articulating a community norm an acceptable compromise?

My point there is essentially that articulating a community norm is, realistically, the best approach we have, and that I think a lot of people have made good efforts to help do so over time and should continue to do so. This thread, as much as it got off to a rocky start (and thanks for acknowledging that, The Straightener, I don't think there was any doubt in our minds that your intention was good so don't sweat it too much) is kind of part and parcel of that.

What "articulating a community norm" means in terms of any kind of forceful implementation is the sticky question. Just as we're not going to ban a swath of questions and answers, we're also not really looking at beating the general membership over the head either.
posted by cortex (staff) at 10:09 AM on February 15, 2010


I like to think when I talk about mental health treatments, it's exclusively from a "what works for me is x,y,z. Maybe look into those," standpoint. But I'll be more careful not to slip into casual and accidental outright referral.

I think that this is a good example of how community and MeTa can actually work for the greater good. I'm among the first to jump in to defend discussion of medical or legal issues here, but it doesn't hurt to check the words for context before posting advice on contentious topics. (Whether it's too-confidently-worded legal or medical advice or slipping into derailing arguments with other posters.)

What bothered me about The Terrible Llama's comment is that I felt like that Xanax suggestion accidentally was too casual. Plenty of people have backup prescriptions of Xanax for situational anxiety attacks, and realistically, it's something that's easy to be "lent" by a well-meaning fellow student or co-worker. Unlike, say lithium, which most people wouldn't have banging around in a pill carrier with their Allegra-D.
posted by desuetude at 10:09 AM on February 15, 2010


I mean, what's the moral basis on which you make recommendations of specific medications, that also happen to be drugs of abuse, knowing that they are sometimes (often?) obtained illegally?

If someone said that they'd just had oral surgery, the doctor had said the pain shouldn't be too bad and gave them prescription-strength Ibuprofen, but the Asker said she was in a lot more pain than expected, you don't think "maybe you should ask your doctor about a strong painkiller, like Vicodin" is a valid answer? Vicodin is a horribly abused drug.
posted by Justinian at 10:11 AM on February 15, 2010


To be fair, I think the coveted title of Worst Mental Health Ask Ever goes to the responses to the woman who thought her boyfriend was trying to kill her.
posted by 8dot3 at 10:11 AM on February 15, 2010


I think talking about community norms is rather difficult considering how many new people come in all the time. I had no idea who ikkyu2 was when I joined up and I was chastised indirectly by him for suggesting a poster visit CrazyMeds. That interaction really changed my perception of these sorts of threads. It never even occurred to me at the time that the asker wouldn't be under the care of a physician (hopefully a psychiatrist)- I just assumed they were looking for more information. But I think there's an assumption made by many awesome physicians/psychiatrists/experts that everyone in their field is equally as dedicated and smart and awesome as they are. I suspect some people come here for advice because they know awesome experts hang around here, and they have doubts about what the person they're seeing IRL is telling them. I don't know if that's still the right reason to ask a question here, but it may be an option people feel more comfortable with than outright questioning their IRL expert.

To be honest, if I hadn't visited CrazyMeds to learn more about the medication I was taking I might have been in big trouble. My GP at the time (yes, I now know I should have been seeing a psychiatrist) had decided to up my dose of Wellbutrin to 600mg when I told him that I wasn't sure if I was feeling better yet. He had neglected to tell me about the risk of seizures at high dosages, the need to avoid alcohol, and the fact that the maximum daily dose is 450mg. So as a result of finding this information on CrazyMeds and then doing more research, I decided I needed to find somebody who knew what the hell they were doing. And if I had known about metafilter at the time this was happening, I might have asked a question about whether or not I should be concerned.
posted by Mouse Army at 10:15 AM on February 15, 2010


I find it hard to imagine that, however depressed/anxious/bipolar/schizophrenic/perfectly normal/in need of therapy/in need of medication/in need of a good hug people happen to be, most people have mistaken posting on Ask.Me for calling up their GP or therapist, making an appointment, receiving a consult and being handed a prescription or given a diagnosis. I mean, they might be depressed, but there's little to no evidence to suggest they're stupider than average.

Everyone who posts here recognizes that they're getting lay advice. I don't think there's any significant danger of someone running off and finding a way to illegally acquire Xanax because teh intarwebs told them it was a good idea. And if they do, well, they have problems even Xanax can't cure.
posted by jacquilynne at 10:19 AM on February 15, 2010 [2 favorites]


I don't think most people who post questions regarding either (a) medicine or (b) law think that they are going to get responses from people who are doctors or lawyers.

see, I think people post questions like the one described to AskMe in the hope of hearing from a bunch of people like them, but further on in the recovery timeline.

it doesn't much matter what actual remedy they recommend - it's the "ahhhh - I'm not the only fucking worm that feels like this all alone in the whole wide world" feeling they get when 5 or 10 or 100 other people say, "yep, I (or my wife or my sister's girlfriend's baby cousin Tracy) had that, and they did this, and now they feel better."

when you don't know what's wrong with you, it's the isolation that really does you in. when you feel less alone, isn't it easier to go find a professional to help you really get somewhere?
posted by toodleydoodley at 10:22 AM on February 15, 2010 [1 favorite]


I could really use one of those "I think someone is bugging my house, what kind of foil should I coat my walls with?" questions right about now. Those are always good.
posted by Justinian at 10:22 AM on February 15, 2010


Those are always good.

Unless you are me, in which case they are always bad.

We'd really like to hash this out in the "community norms" sort of way since, as cortex says, we can't do much usefully in the legislative arena. And it's tough because even if we encourage people to personalize their own experience so it's clear that they're not prescribing meds, you're still going to get "You know taking a valium before you fly might be a really good idea" sorts of answers at the same time as you get angry people being angry because so many people suggest therapy, or exercise. To me this is part of knowing and understanding how to answer questions and help solving problems, but just as there's no right way to ask a question [though there are better and worse ways] there is similarly no right way to answer them [though again, better and worse].

From our vantage point, we are a lot harsher on anonymous questions where the only reasonable answer we think people are going to get is "go to a doctor/lawyer" or where people are anonymously asking very specific medication interaction questions. I think people react to these sorts of questions, the one we're mainly talking about, more strongly when it seems that the OP really doesn't have a handle on their issues, whatever they are, and this is true for relationship issues as well as medical/legal ones, but we worry more for the latter than the former, most times.
posted by jessamyn (temp) at 10:31 AM on February 15, 2010


If someone said that they'd just had oral surgery, the doctor had said the pain shouldn't be too bad and gave them prescription-strength Ibuprofen, but the Asker said she was in a lot more pain than expected, you don't think "maybe you should ask your doctor about a strong painkiller, like Vicodin" is a valid answer? Vicodin is a horribly abused drug.

This is not a comparable situation. In the situation you describe someone has a proximate cause for their pain and is under the care of a doctor.
posted by OmieWise at 10:33 AM on February 15, 2010


But in general AskMe is good about telling people to seek professional help.

I don't know what the answer is re: askme commenters making diagnoses and recommending meds. that said, the idea that AskMe is good about being medically responsible in general is troubling to me. sure, we're good about it generally. and without trying to suggest a course of action (because I really don't know what one would be), those specific instances where we might not be good about it are pretty frightening, as an idea.
posted by shmegegge at 10:42 AM on February 15, 2010


Oh, and I am sorry for starting this off so poorly, that was my fault, I apologize for that and I will take deep breaths before my next MetaTalk.

Let's hug it out!
posted by Brandon Blatcher at 10:46 AM on February 15, 2010 [5 favorites]


*hugz*
posted by The Straightener at 10:47 AM on February 15, 2010 [5 favorites]


I just wanted to add a data point as a user, not an admin, but I've found in the past that being armed with a little knowledge from someone that has gone through similar things at a doctor has made a TREMENDOUS difference in how care was doled out to me.

Case in point: The Dentist. I've been terrified of the dentist since I was a small child and novacaine didn't really work on me, so drilling was intensely painful no matter how many shots to the mouth I took.

My whole life I've avoided the dentist and when I finally tried to right my past wrongs and go regularly I would be perfectly clear with new dentists that I was terrifed of being there and that I had a low threshold for pain. Half of the 5-10 dentists I've seen in the past few years laughed at me or mocked me whenever I expressed discomfort (I stopped going to those assholes). The other half would suggest yoga, not drinking beer (it's rare that I drink beer already), or relaxation techniques. Some would say "well, if you're really bad there are other things but I don't want to rush down that path" and we'd never try them or even discuss them.

A few years ago I asked on Ask MeFi for advice and got some somewhat dodgy advice to pop a valium and ask for nitrous oxide at the dentist. I seem to recall harder things than valium were mentioned.

The long-story-short of it is that the next time I walked into a new dentist, said I had anxiety and told them flat out that I would like nitrous oxide, the entire experience changed. It was like a magic word that opened the doors and they were compassionate, constantly check on my comfort, and do everything they can to make sure I have a tolerable time at the dentist so I can return. From earlier interactions with dentists, I was sure that nitrous oxide must be some dangerous substance that they avoided for good reason but found out it's mostly harmless and some dentists hate it because it adds time in the chair and messes up their schedules.

So in the jargon-filled world of the medical profession, with caveats that people on Ask MeFi are not your doctor and to take their advice with a grain of salt, it does really help to hear from others with experience and to gain a bit of knowledge you can use in conversations with your real medical professional.
posted by mathowie (staff) at 10:54 AM on February 15, 2010 [11 favorites]


The issue with xanax is that you take it, it acts relatively quickly which is great if you're having a panic attack or freaking out about the dentist. Or you take one whenever you fly. It wears off relatively quickly. Yay, agoraphobics can go outside without the crippling fear of a panic attack.

GAD is anxiety a lot of the time in multiple situations. You take a xanax, it wears off quickly. Uh oh, you get anxious again. What helps with the anxiety? Xanax. You take another one. At some point it loses its effectiveness and you develop a physical dependency. If you have a good shrink, they have been transitioning you to a longer term solution. That's cool. But then you have to taper off of the xanax which takes a while. You have to fill a controlled substance scrip which is a huge pain in the ass. There are other benzos that don't string you out nearly as much and they're easier to get off of.

Anyway, I was overly harsh in my criticism of your suggestion, Justinian, but xanax is really rough to get off of when you take it as much as you probably need to take it for GAD and there are so many options that are much safer and easier on the person taking them.

Something else to consider is the frightening physical withdrawal. You lose your health insurance and suddenly you have a huge problem--getting a controlled substance while paying your doctor and pharmacist out of pocket, if you can. If you can't get a shrink to prescribe or you can't pay, you get the fun option of going through miserable and possibly dangerous withdrawal by yourself, or maybe going to an ER which can range from embarrassing to traumatic.

So yeah, I'm not a shrink either, I've said some stupid stuff in my day, and I know you mean well but think about it before you make these kinds of suggestions.
posted by kathrineg at 11:03 AM on February 15, 2010 [1 favorite]


So in the jargon-filled world of the medical profession, with caveats that people on Ask MeFi are not your doctor and to take their advice with a grain of salt, it does really help to hear from others with experience and to gain a bit of knowledge you can use in conversations with your real medical professional.

I couldn't agree more! Especially now when Doctors hustle me through their office like widgets on an assembly line (which I'm sure has as much to do with the HMOs as it does the specific doctors). I need to have my questions and concerns written down ahead of time.

They may harrumph about self-diagnosis but I've got their attention focused on my specific issues and how they can treat them.
posted by cjets at 11:14 AM on February 15, 2010


jacquilynne, people with mental illnesses often lack judgment. Either due to their illness or because they are desperate to relieve their suffering or because we all lack judgment sometimes.
posted by kathrineg at 11:20 AM on February 15, 2010


I've said some stupid stuff in my day, and I know you mean well but think about it before you make these kinds of suggestions.

Don't patronize me. You're presenting personal anecdotes and acting as though they are medical consensus or hard data. Here:
Alprazolam is indicated for the management of anxiety disorder (a condition corresponding most closely to the APA Diagnostic and Statistical Manual DSM-III-R diagnosis of generalized anxiety disorder)
Anxiety Disorders are what alprazolam is for. Does the OP have GAD? I dunno, maybe. Is suggesting he talk to his shrink about it and consider medication such as alprazolam somehow crazy talk? No, no it isn't. You seem to have a chip on your shoulder about Xanax. I'm sorry you had a bad experience with it, but that doesn't change the scientific consensus.

Also, you seem unaware that it is now available in an XR (extended release) form.

You lose your health insurance and suddenly you have a huge problem--getting a controlled substance while paying your doctor and pharmacist out of pocket

This is true of any medication. A diabetic who relies on insulin who loses his health insurance will also need to buy it out of pocket. Luckily, alprazolam is DIRT CHEAP. We're talking $10 or something for a month. It's generic.
posted by Justinian at 11:21 AM on February 15, 2010 [1 favorite]


So, um, what are you doing later? Want to go grab some taters?
posted by Brandon Blatcher at 11:21 AM on February 15, 2010 [1 favorite]


jacquilynne, people with mental illnesses often lack judgment. Either due to their illness or because they are desperate to relieve their suffering or because we all lack judgment sometimes.

Absent any specific evidence to suggest they are lacking that kind of judgment, I don't think we should refrain from posting our experiences on Metafilter because someone might exhibit extremely poor judgment and do something illegal and stupid as a result.
posted by jacquilynne at 11:28 AM on February 15, 2010 [1 favorite]


Never realized that so many MeFi members worked for big pharma before reading this. Take a pill!
posted by fixedgear at 11:38 AM on February 15, 2010


So, um, what are you doing later? Want to go grab some taters?

Hardcore taters???
posted by Justinian at 11:44 AM on February 15, 2010


The long-story-short of it is that the next time I walked into a new dentist, said I had anxiety and told them flat out that I would like nitrous oxide, the entire experience changed.

Oh yeah, Nitrous totally makes the dentist a better place to be. The dentist I'm with now, when confronting a lot of work I needed done had an even better suggestion; they keep an anesthesiologist on staff and they basically roofied my ass for four hours. The down side was that I needed my wife to drop me off and pick me up, but the upside was that, not only was I not in any pain, I don't even remember the day that I went in.

It's just a hole in my memory that ended with a fixed mouth. Recommended.
posted by quin at 11:48 AM on February 15, 2010


Really sorry to hear about your cat, Justinian.

You've mentioned him before, and I generally picture you shoving him away from the keyboard so you can make your posts.
posted by jamjam at 11:59 AM on February 15, 2010


You're right, Justinian, I'm the only person ever to have a problem with Xanax. Good catch!

Xanax XR. Huh. Maybe you should pop back in there and suggest it.
posted by kathrineg at 12:00 PM on February 15, 2010


Oh and the big issue is not the cost of the xanax itself, but the cost of seeing a psychiatrist every month. For some people it's doable, for some people it's a huge problem. I recall an askme by someone who was running out and had very few options because of his insurance situation.

I imagine the xanax xr isn't generic yet.
posted by kathrineg at 12:05 PM on February 15, 2010


jacquilynne, people with mental illnesses often lack judgment. Either due to their illness or because they are desperate to relieve their suffering or because we all lack judgment sometimes.

That's an incredible over generalization of people with mental illness. There are dozens of mental illnesses and not all of them automatically mean the person who suffers from them "lack judgment."

I have bipolar. I've had bipolar for over 20 years. While I have, on occasion, had lapses in judgment due to mania or hypo mania, most of the time I'm quite level-headed thank you very much. Lately my fibromyalgia has caused more mind-fogginess than my bipolar ever has. I've only had that for two years and it's made my life hell. It's the PAIN that causes me to lose judgement, not my mental health.

Please refrain from clumping people with mental issues in to a group like that. I'd appreciate it.
posted by patheral at 12:18 PM on February 15, 2010 [9 favorites]


Everyone knows anxiety is caused by the evil eye. You're anxious because this evil eye is watching you and being stared at evilly tends to make a person nervous. What you need is a bucket of water to melt the witch with.

Alprazolam is a good name for a baby. You can call it "Al" or "Praz" or "Zol" or "Lam" for short. I've got dibs on it next time there's a "name my baby" thread.
posted by anniecat at 12:34 PM on February 15, 2010 [2 favorites]


OK, so sorry to comment strongly in the beginning and then not check back in awhile. But really generally, yes, I agree that the idea of metafite's "diagnosing" from their computers is ridiculous, Straightener.

My main point was that discussion re: personal anecdotes by people using the same/similar medication and also discussion about health issues that people share, is very useful information. The casual tossing around of diagnoses/authoritative viewpoints on serious health issues is annoying at best, and damaging at worst. But how to draw that line in an easy, bright line fashion (thanks for the image, Cortex), is something I bet would be hard to accomplish. Given that a lot of people find these community resources helpful, and given that most AskMe's do a good job of self-policing (either by saying: 'see a doctor', or 'I am not a doctor', and by the general knowledge that when you seek help on metafilter, you aren't enlisting the help of professionals), I don't know how, if at all, that line would be drawn. But luckily I don't have to draw that line, the mods do. And it seems that above, the moderators have already expressed what I meant to say, albeit more eloquently.

I will join in the hugs now.
posted by HabeasCorpus at 12:51 PM on February 15, 2010


I agree with The Straightener, there is a huge amount of mental health bullshit passing for answers on AskMe, and much of it is not only incorrect, but potentially harmful.

Is there some reason this is only important when it's mental health bullshit?

I see no end of bad advice on legal and financial matters, often presented without caveat or uncertainty regardless of how ignorant the person answering really is. Those answers often advise questioners to do certain things that would cause them just as much harm in quality-of-life as the pharma advice that gets given AND there's no doctor/pharmacist gateway to slow them down from taking these actions.

Bad advice is given on AskMe all the time. One hopes the community steps up and says "that's not true" or "here's a more intelligent way to approach this - the above is reckless and a bad idea." If you think asking questions of a largely anonymous group of people on the internet is worthwhile then you pretty much have accepted this as a fact.

Or as Horace Rumple more succinctly said: Given the billions of dollars spent every year to push the message "Ask your doctor about Obecalp" it seems a little disproportionate to be this upset about an AskMe thread where people make suggestions they actually believe in.

Everything else in The World presumes that people are going to have to exhibit some amount of caution in what advice they take. Expecting AskMe to somehow be above that seems unrealistic.
posted by phearlez at 12:54 PM on February 15, 2010 [2 favorites]


> You're right, Justinian, I'm the only person ever to have a problem with Xanax. Good catch! Xanax XR. Huh. Maybe you should pop back in there and suggest it.

Oh, grow up.
posted by Ambrosia Voyeur at 1:06 PM on February 15, 2010 [1 favorite]


Oh, grow up.

TAKE A CHILL PILL
posted by Sys Rq at 1:10 PM on February 15, 2010


What you need is a bucket of water to melt the witch with.

oh baloney. everyone knows the only way to deal with mal de ojo is to tie up your hair with thread, or get baptised. or both.
posted by toodleydoodley at 1:11 PM on February 15, 2010


OmieWise: In mental health questions, consensus often quickly forms, but it's uninformed and incorrect consensus.

I admit to not reading the whole thread. But I just want to point out that this happens in nearly every kind of question on AskMe where the answer isn't immediately obvious.

The wisdom of crowds is good for indicating what most people think, but not so good for indicating the actual truth.

I don't know what the answer is. Maybe a disclaimer that says: "Note: Even if 100 people answer your question the same way, and with great enthusiasm and articulation, it's still possible that every one of them was completely wrong."
posted by bingo at 1:15 PM on February 15, 2010


Everything else in The World presumes that people are going to have to exhibit some amount of caution in what advice they take. Expecting AskMe to somehow be above that seems unrealistic.

A member of Metafilter has suggested "hey, let's treat this topic a little gently and be careful what we say, for everyone's benefit." We've had a LOT of discussions in Metatalk about how we treat various issues, not just mental health. I think it's okay to consider this point without going all zero-sum mentality about it.
posted by desuetude at 1:18 PM on February 15, 2010


oh baloney. everyone knows the only way to deal with mal de ojo is to tie up your hair with thread, or get baptised. or both.

Or hang up one of these.
posted by Burhanistan at 1:20 PM on February 15, 2010


It would mean not recommending an aspirin for a head ache

Actually, no one should ever be recommending someone else take non steroidal anti-inflammatories without some knowledge of the patient's medical background. No doctor would make such a sweeping statement. A decent proportion of the population don't tolerate them and it can be very dangerous advice. The only advice you can give there is to take a painkiller that you tolerate and to talk to a pharmacist if you don't know which one that is. Anyone giving advice that doesn't know the possible side effects of the drugs they're suggesting needs to not suggest them, particularly when the drugs are OTC. I'm serious here, NSAIDs can really fuck you up if you take them when counterindicated.

The other one that pisses me off is whenever inflammatory bowel disease comes up someone generally tells the patient to increase fibre intake, a potentially disastrous course of action which, for the wrong patient, can lead to hospitalisation. Again only medical professionals should be giving medical advice, and dietary advice for someone with a serious GI disorder is medical advice.

As for advice like "take Xanax", you're greatly increasing the risk of diagnosis and prescription shopping, something I've seen on Ask plenty of times before, and making it at the least much harder for the asker to actually get the appropriate medical advice.

The fact that many of you, including the moderators, don't understand why these are genuinely serious issues that need to be treated carefully just shows how unqualified you are to be giving this advice (or moderating the giving of it). The Straightener is actually correct and not at all overreacting, no one here ever should be suggesting ANY treatment options unless you're a qualified medical professional who has examined the person asking (in which case you should be talking during the exam not on a website). Eventually someone will end up in hospital for something as apparently innocuous as inappropriate pain medication, there will no doubt be lawsuits and it will all suck.

Bad financial advice doesn't usually have the potential to send someone to the hospital, whereas bad aspirin advice actually might.
posted by shelleycat at 1:22 PM on February 15, 2010


Vaguely related - an interesting enough article, but not quite worthy of a FPP:

One of the main targets of [scholar-in residence at the University of California and a partner architect with Microsoft] Lanier's critique is the concept of the "wisdom of the crowds" or the "hive mind". This is the idea beloved of so many social media enthusiasts that the collective wisdom of a large number of people, generally harnessed online, will exceed that of the individual. Wikipedia is the classic example often cited in support of this theory.

Lanier believes that by fetishising and over-stating the power of this collective so-called intelligence we undervalue individual humans.

"The 'wisdom of the crowds' effect should be thought of as a tool. The value of a tool is its usefulness in accomplishing a task. The point should never be the glorification of the tool."

posted by UbuRoivas at 1:22 PM on February 15, 2010 [1 favorite]


I disagree with the implication that a patient going to the doctor with a medication in mind only adds "noise" to the conversation between the doctor and patient.

I have high blood pressure. My doctor put me on an ACE inhibitor which made me cough and didn't actually help with the blood pressure that much (so she had me take a diuretic as well.) I did a little research online and found out that ARBs have less risk of causing cough, and also have a protective effect on diabetic's kidneys. She never mentioned this type of drug as an option, but when I brought it up to her she was willing to try it. My blood pressure dropped like a stone into the normal range within days, I was able to get off the diuretic, and I've never had a single side effect. Why did my doctor not suggest this to me when I first told her of my side effects? I do not know, but because I came in with an idea of my own I'm now doing well.

I've also suggested to many people who are having sexual difficulties on SSRI's that they ask their doctors about adding Wellbutrin to their drug regimen. I'm always surprised at the number of people whose doctor never even mentioned this as a possibility. I know of one case where the person I mentioned this to brought it up with her doctor who was happy to give it a try, and the person has received great benefit from the addition of the new med.

Again, I have no idea why her doctor had not suggested this to her in the first place, but if it weren't for my bringing the possibility to her attention she might not have gotten a treatment which turned out to be very effective for her.

As a patient, I don't stick around very long with a doctor who is offended when I make suggestions and decisions about my own medical care. My input is not "noise", it's one side of what should be a two-way conversation.
posted by Serene Empress Dork at 1:22 PM on February 15, 2010 [6 favorites]


I don't have enough time right now to read this whole thread but I wanted to come in hear to get some specific feedback. Surely there's some middle ground here somewhere.

I'm not really sure how I got on the dolling out specific medical advice list. If anything I think I went as far as anyone should go when offering mental health advice on the internet. I probably should have worded the "mystery diagnosis" part differently but anxiety is a pretty broad term. It's not like I said "according to the DSM you have GAD". I also fail to see what's wrong with stating the general type of drug that worked for you as long as you stress that they need to actually talk to a doctor about it. I didn't say you need to take drug "X".

I think some posts were out of line. Pulling a specific diagnosis from the DSM like your some kind of expert probably shouldn't happen. Recommending specific drugs like xanax probably should not happen especially without stressing that they need to see a mental health professional. Another thing that bothered me was people suggesting life experiences that may have caused the disorder. Stuff like "Were you raised by an extremely over-controlling person?" is totally not necessary.

As far as I recall there has been one suicide by an active member with no evidence that non-mental health professionals on askme contributed to it. There was one schizophrenic who got all kinds of random specific diagnoses from askme but got, according to them at least, the right diagnosis by a real life mental health professional in the end. And there was one bipolar person who was manic and posted a rambling question to askme. She was advised to go to the ER with her meds. She did that, got admitted and got her meds sorted out. That seems like a pretty good track record for a random forum on the internet.

Never realized that so many MeFi members worked for big pharma before reading this. Take a pill!

This is a good example of why people should talk about what medications they take. All the hurf durf big pharm why do you have to take a pill stuff, even if made in jest, is more toxic than most of the the mental health advice on askme.
posted by Procloeon at 1:27 PM on February 15, 2010 [1 favorite]


The fact that many of you, including the moderators, don't understand why these are genuinely serious issues that need to be treated carefully just shows how unqualified you are to be giving this advice (or moderating the giving of it).

We are not saying they're not serious or that we don't understand the issues. We are saying they don't differ from these situations in the real world of "ask a bunch of people" sufficiently that we think there needs to be a legislative approach to them. We think having a terms of service that says something to the effect of "hey this isn't intended to substitute for medical/legal/professional advice" is a good idea.

We literally can not have AskMe continue to exist if you think we should be moderating the content of responses that people give in health and legal questions beyond the basic moderation that we do now. We can't do that job. We can't repurpose the site to have doctors/lawyers do that job. Even if doctors/lawyers could do that job, we would have these same problems because the site is moderated after-the-fact and people could still give bad information. We'd have to get into endless fights about what good or bad information even IS.

So, I understand that some people feel very strongly about this and I'm not thrilled with that particular question or the sort of not-getting-it vibe that I get from the question-asker. That said, people are welcome to reply "that is not a good idea, here's why" to bad information, but I hope you understand that people are also still going to suggest aspirin for headaches.
posted by jessamyn (temp) at 1:28 PM on February 15, 2010 [4 favorites]


To be really clear: the place the line needs to be drawn is when an answerer gives a specific diagnosis or directly suggests a specific medication. I think you have x, you should try taking y, even you should ask your doctor to give you y, those are not acceptable. Even if the answer appears innocuous, like suggesting NSAIDs, it's still not acceptable when the person suggesting it clearly doesn't fully understand what they're suggesting (and we should err on the side of caution with this stuff). There does need to be a bright hard line that stops people doing these things because it's dangerous and not actually helpful in the end.

Suggestions of things (particularly diagnoses) to talk about with a doctor is noticeably different advice, but again specific medication suggestions are generally inappropriate particularly when someone hasn't even been diagnosed. It's bad enough that prescription medications are allowed to advertise (in my country too btw), giving this information is a job for a doctor or pharmacist not a bunch of under-informed lay people. Even saying x worked for me! doesn't mean shit, medications work differently for different people and different diseases and we're back to prescription shopping. General classes of medication for specific diagnoses, sure that's worth mentioning, specific medications no.

If you can't tell the difference between directly telling someone they have a disease or should take a drug and suggestions that they talk to a doctor about a general area of concern then you shouldn't be answering those questions.
posted by shelleycat at 1:41 PM on February 15, 2010 [1 favorite]


but I hope you understand that people are also still going to suggest aspirin for headaches.

As long as you're aware and comfortable with the fact that that's potentially dangerous advice with serous consequences, and is advice that no professional would give in that form.
posted by shelleycat at 1:45 PM on February 15, 2010


I'm okay with that, yeah. I'm also confident that someone else will come along and explain why aspirin is risky/problematic.
posted by jessamyn (temp) at 1:46 PM on February 15, 2010


potentially dangerous advice with serous consequences

Are you properly qualified to talk about the effects of aspirin on our serous fluids?
posted by UbuRoivas at 1:48 PM on February 15, 2010


As long as you're aware and comfortable with the fact that that's potentially dangerous advice with serous consequences, and is advice that no professional would give in that form.

I recently got all sorts of annoyed on that recent thread about the dude's girlfriend who was afraid of getting pregnant through fingering after the guy removed the condom, because several responders (mostly male) were like SHE SHOULD BE ON THE PILL.

But you know what? That's probably exactly what a doctor would say. In fact, when I was nervous about getting knocked up at 18 (despite being a virgin!), the doctor threw pills at my paranoia, too. Hell, even once I developed high blood pressure from the pill, a different doctor was reluctant to take me off of it.

It's not just birth control, either. Every time I get a sinus infection, I'm given antibiotics. When I was depressed in college, I had to be pretty insistent with my psychologist that I didn't want a psychiatric referral in the first ten minutes of meeting her. The husband was misdiagnosed as bipolar and put on pretty raucous anti-seizure meds to treat it a few years ago. I want to know where all of these reluctant-to-give-aspirin-to-patients doctors are. I'm not particularly anti medical establishment, but I've certainly never met these mythic professionals.
posted by PhoBWanKenobi at 1:52 PM on February 15, 2010 [4 favorites]


My rural america doctor is actually pretty med-averse. I'd been grappling with some anxiety a long while back and, after talking to some friends including some doctor friends about why benzos might help with my short-lived situation-based anxiety problem, I talked to my doctor about them during my checkup. He was really nice about it but was like "Well why is what you're doing now not working?" and I said I was already exercising myself into a puddle, was eating right and all the rest, but still found drinking to be the only decent way I could fall asleep before 4 am. He was like "that sounds like it's working okay to me..." Nice guy and I guess for me personally I'm okay with having to be assertive to get meds like this, but I always wonder about other people who might not be as assertive, and how they'd manage with their anxiety and their drinking because their doc thought that was the best approach.
posted by jessamyn (temp) at 1:57 PM on February 15, 2010


As long as you're aware and comfortable with the fact that that's potentially dangerous advice with serous consequences, and is advice that no professional would give in that form.

What percentage of the people who take aspirin, tylenol, etc, do you suppose consult with a doctor or pharmacist about their specific condition and medical history before they do it? 0.01%? Maybe less?

People habitually and frequently offer each other tylenol and aspirin and such. If that's a serious problem, it ain't a Metafilter problem, and Metafilter sure isn't going to be able to solve it.
posted by jacquilynne at 2:01 PM on February 15, 2010


You're right, Justinian, I'm the only person ever to have a problem with Xanax. Good catch!

You're missing the point. You're not saying "OP, you should be careful about benzodiazepines because they are serious meds with side effects". You're saying, "No-one should mention Xanax despite it being a very typical treatment for anxiety disorders because some people, including myself, have had problems with it and I don't like it".

See the difference? You're making an ex cathedra pronouncement about the acceptability of a particular treatment option based on the experience of some patients despite that treatment being almost the gold standard for certain types of people.

There are a ton of people who will tell you the same thing about Lexapro. It's terrible! It's awful! It's impossible to stop taking! It only masks the problem! There are a lot of people who will tell you similar things about virtually any medication you care to name including acetaminophen and ibuprofen. Which is why the standard should be whether it is an accepted and effective treatment option, not whether kathrineg has a personal issue with it.
posted by Justinian at 2:02 PM on February 15, 2010 [2 favorites]


Ok, what's the problem with aspirin for headaches? I'm clueless on this subject, hope me MeTa.
posted by Brandon Blatcher at 2:03 PM on February 15, 2010


the place the line needs to be drawn is when an answerer gives a specific diagnosis or directly suggests a specific medication. I think you have x, you should try taking y, even you should ask your doctor to give you y, those are not acceptable.

shelleycat, again: If you don't trust the doctor to reply appropriately to questions of this kind, then why do you trust him or her to diagnose and medicate properly in the first place?

The doctor is either competent or not. As Horace noted above, rx drug companies are pushing their remedies ("if you have x, y, or z symptoms...") all over the place. Professional health workers have to be prepared to have these conversations with patients.
posted by torticat at 2:05 PM on February 15, 2010


giving this information is a job for a doctor or pharmacist

Congratulations, you've re-invented the guild system! I'm sure it would work out much better this time around.
posted by Justinian at 2:06 PM on February 15, 2010 [1 favorite]


BrandonBlatcher: Reye's Syndrome is the biggie that I'm aware of [in kids and teens], though it can cause problems with gastrointestnal bleeding apparently too. Mayo Clinic says this.
posted by jessamyn (temp) at 2:08 PM on February 15, 2010


Ok, what's the problem with aspirin for headaches? I'm clueless on this subject, hope me MeTa.

It's a blood thinner! Your blood will get too skinny!
posted by Sys Rq at 2:12 PM on February 15, 2010


When I see mental health related AskMe questions, I am drawn to reading them because of my connection to the field as a professional, but I imagine that a lot of people are also interested because of their experiences with similar issues or in general, as consumers of MH services, and the perceived expertise that everyone has once they've dealt with something in their lives... which is a HUUUGEEEE part of what fuels AskMe, too). I use my best judgment to try to suggest that the OP consider researching the quacky/pseudoscientific therapy or technique some random person suggested, to mention the inappropriateness of a particular diagnostic suggestion made upthread, to share as much potentially helpful info as I can, and/or to strongly encourage people to seek professionals. I see that as part of what I can offer as a helpful AskMe answerer: knowledgeable advice backed up solidly by my related education and experience, a reality check, whatever. I've never given anyone advice on how to fix their cars, because although I have driven plenty of cars and even changed oil and transmission fluid, I don't actually know anything about cars, and I can realize that.

I think it's helpful to look at AskMe questions as though they are written by Actual Real People, and to fully recognize that each one of us has knowledge in areas A through M that is very limited or nonexistent, areas N through W that could be potentially useful but require us to qualify our position as a non-expert and furthermore to defer to those who might actually be experts, and areas X, Y, and Z that are your specialty areas! Go forth and share! (Note: I also want to extend the invitation to consider this model to all of the men who are not gynecologists but answer questions relating to the health of vaginas. YOU GIVE OUT WRONG INFORMATION ALL THE TIME, BECAUSE YOU DO NOT ACTUALLY UNDERSTAND VAGINAS. STOP IT.)

I don't know that it's the mods' job to know/monitor/delete-hammer where MH professional ethics are concerned. I think it's part of what is appealing to people about AskMe--that, in our community, there are several different types of professionals in many different important arenas, and people who have just had some experiences that gave them some insight about a process or thing or whatever. It's already really difficult to give input as a MH professional online, but asking the mods to do so would be even more tenuous.

So yes, stopping the diagnoses and recommendations of medications should stop. Not even the people who are qualified and legally allowed to do those things in their professional offices should do that on the internet, so neither should you.
posted by so_gracefully at 2:12 PM on February 15, 2010


Xanax is appropriate for some people, not for others, better for some types of anxiety, not so much for others, also there are other alternatives including medications like Buspar and antihistimines like Vistiril that a lot of people report great results with that do not have the habit forming component of Xanax or other benzos. Only a doctor directly involved with this particular person is capable of making the determination of which is best for the symptoms presenting.

But all of that is totally moot, because if you page back through this poster's history, you'll find that he/she once claimed to have been diagnosed with "serious social anxiety" and a near case of Asperger's only to state a few weeks later, after peppering AskMe with similar questions on an almost weekly basis, that he/she absolutely does not nor ever had anything like Aspergers and the same therapist who only weeks previously diagnosed him/her with "serious social anxiety" now says he/she only has a bad case of over thinking and no mental health disorder at all.

Which is why we shouldn't be throwing labels out at this person. That's exactly what he/she has been fishing for on AskMe for the past couple months, despite the fact that it appears his/her treating therapist doesn't want him/her trying on stimatizing labels.
posted by The Straightener at 2:12 PM on February 15, 2010 [1 favorite]


You're just reading those comments wrong.

You need to be mentally adjusting them to, "Ask your doctor if ____________ is right for you."

Because, hey, you know what? IT'S PRESCRIPTION MEDICATION. Presumably, the OP would be consulting a doctor about it if you're going to be taking it. When someone comments, "Hey, I have a bunch of extra Xanax you can take off my hands," then you can get worried.

Additionally, as usual, there is a lot of conflicting advice in that thread for the OP to sort out. How do you suppose the OP will go about that? My money is on consults a physician.


It's not a safe assumption that askers will make this same mental adjustment. Also, you may lose your money. Prescription drugs are pretty easy to get online. I've known people who have self-medicated via this route for years.

So, yes. Be careful with breezily tossing out a medication recommendation, and if you want to, do not assume the asker will automatically add "but ask your doctor before doing anything."
posted by ignignokt at 2:16 PM on February 15, 2010


shelleycat writes "Actually, no one should ever be recommending someone else take non steroidal anti-inflammatories without some knowledge of the patient's medical background. No doctor would make such a sweeping statement. A decent proportion of the population don't tolerate them and it can be very dangerous advice. The only advice you can give there is to take a painkiller that you tolerate and to talk to a pharmacist if you don't know which one that is. Anyone giving advice that doesn't know the possible side effects of the drugs they're suggesting needs to not suggest them, particularly when the drugs are OTC. I'm serious here, NSAIDs can really fuck you up if you take them when counterindicated."

Like the nuts example earlier one would hope that if an aspirin is going to send you to the hospital you'd know that before soliciting the advice of strangers and then blindly taking it when they suggest it. Really that goes with anything widely available over the counter. Curbing that kind of advice would also entail curbing, for example, cooking/recipe advice because of the wide range of allergies that can put people in the hospital. In fact suggestion of over the counter medication may be safer than more general advice because most (all?) OTC medications seem to come with inserts outlining side effects and contra indications.

We're rehashing a debate we had just last month regarding law advice. Bad advice abounds on AskMe on the Web on the Internet in life. Lawyers or doctors or other professionals are in all in niche specializations were they can see the potential for harm and because of their professional ethics this bothers them but it isn't in any way unique and curbing it across the board would essentially kill the vast majority of ask me questions right from the get go. The electrical advice given is often directly dangerous of person or property. Even something as innocuous as "Name my Dog" could get someone hospitalized if one of the suggestions happened to be a slur.

shelleycat writes "Eventually someone will end up in hospital for something as apparently innocuous as inappropriate pain medication, there will no doubt be lawsuits and it will all suck."

As I stated last go around their isn't anything unique about AskMe as far as bad advice goes and I've never heard of either a lay person or the forum hosting the erroneous advice being sued. Centuries (Millennia?) of collective experience and no one could come up with a case.

so_gracefully writes "(Note: I also want to extend the invitation to consider this model to all of the men who are not gynecologists but answer questions relating to the health of vaginas. YOU GIVE OUT WRONG INFORMATION ALL THE TIME, BECAUSE YOU DO NOT ACTUALLY UNDERSTAND VAGINAS. STOP IT.)"

A peruse of AskMe will show that men aren't the only ones who don't understand vaginas.
posted by Mitheral at 2:21 PM on February 15, 2010 [4 favorites]


Only a doctor directly involved with this particular person is capable of making the determination of which is best for the symptoms presenting.

Luckily for everyone involved, only a doctor directly involved with this particular person is capable of writing a prescription for potential medication.

Arguing that they might buy some from their local dealer is like saying that we shouldn't help someone figure out how to burn to a CD because they might pirate music, or we shouldn't tell someone that what happened to them sounds like sexual harassment and to ask a lawyer about it because they might instead ask Uncle Bill and get bad legal advice.

We possess individual volition. If someone is an idiot and decides to ask Uncle Bill to represent them in court instead of getting actual legal advice, that is not anyone else's responsibility. Similarly if someone orders medication over the internet from god-knows-where instead of asking their doctor if it is appropriate, that is not anyone else's responsibility.

Too many people are far too willing to deny other people agency and autonomy. We don't have a guild system. Doctors and lawyers are neither guild masters nor Plato's philosopher kings. It is not your responsibility to protect people from every single possible consequence of their own bad decisions.
posted by Justinian at 2:25 PM on February 15, 2010


It's a blood thinner! Your blood will get too skinny!

On the plus side, your blood will be able to fly on Southwest.
posted by Horace Rumpole at 3:15 PM on February 15, 2010 [3 favorites]


As much as the answers in that question are ... not all that great, as a whole ... in part, it's difficult to see what would be good answers. I know this thread focuses on answers as the point of intervention, and that does seem like one important focus. But I have been wondering for awhile, whether there might be more intervention at the question phase.

About the only answer that strikes me as entirely appropriate was polymodus's, in part because he or she said only "this is a question for a good therapist, so if the one you have isn't helping, try others" and "it might help to focus on 2-3 symptoms." That seems to be about the only good answer to a question that boils down to "please diagnose my mental health problem and/or learning (dis)abilities."

This question reminds me of other "here is a broad description of my life, what am I doing wrong?" questions, and those often don't go well. People on the internet can't really do a great job diagnosing someone (either for possible missing social skills or psychological health problems) on the basis of a few hundred words.
posted by salvia at 3:19 PM on February 15, 2010


There is no reason any Mefite should be recommending that any other Mefite take a medication under any circumstances whatsoever.

Hyperbole. Keep your thoughts and pencils sharp, people.
posted by polymodus at 3:44 PM on February 15, 2010 [1 favorite]


I'm not so sure what's wrong with answering in the context of "this was my experience." People are not rats in a lab. Oh wait, yes we are. We are rats in the lab of the mental health industry and how dare we question it because you have a degree?

I rarely go into AskMe anymore because a recent answer I gave got a nasty "thanks, Oprah," and a bunch of derogatory remarks after that.

So have fun, y'all, overthinking a plate of beans. We do indeed give each other advice and relate our experiences with paternalistic doctors, overbearing therapists, and the awful side effects of the medications they give us in the name of science.

My degree: growing up for 20 years with mentally ill family members. Being married to one. Seeing people through multiple hospitalizations, drug experiments, abuses by the mental health "experts," and electroshock therapy. Cloropromazine handed out like candy with an unlimited prescription, and being told by doctors, "oh just let me do my job, dear, you don't know anything," after seeing my ex husband sitting in the visitors' room holding his hands apart and saying, "can you see it? Can you see the bright yellow plastic wrap between my hands?" After the expert shrink had given him yet another mind-altering drug. Then, Mr. Expert Doctor came to ME after he diddled around and my husband had almost DIED from dehydration, as he was catatonic and would neither eat nor drink and asked me to convince this poor man to get shock therapy.

So take your views and stuff them. I will say what I want, when I want. If not in AskMe, because you want to censor the real world's experience and knowledge, which doesn't come from a college with a curriculum and books, but from real life horrific experiences.

I am not Oprah.
posted by Marie Mon Dieu at 3:55 PM on February 15, 2010 [10 favorites]


Even saying x worked for me! doesn't mean shit,

Surely, being an expert and all, you are aware that their is often still a stigma attached to some types of medication, at least in this country. Posting questions like this online suggests that the poster may be uneasy about actually approaching someone in real life to talk about it. Telling someone that it worked for you means several things. Someone can relate somewhat to your issue even if it isn't exactly the same, there is someone else in the world who needs the meds you may need, it's OK to actually drag yourself to a medical professional to talk about that, and there are so many meds that your doctor may not actually know that one of them exists, as Serene Empress Dork clearly pointed out.

Of course they could have other motives, they could be shopping for meds, or a specific diagnosis, or trying to game the system some other way, or buy it on the street. But you aren't going to stop that. They just had a grand jury hearing for a doctor in my home state who was primarily just a benzo pusher, he was doing it for more than a decade, his network was huge. Me posting on Metafilter isn't going to cause or prevent stuff like that.

That's exactly what he/she has been fishing for on AskMe for the past couple months

I've been reading all of Gardens posts and avoided responding to them until now. As far as I can remember Garden never mentioned any medication in the past and didn't mention any in the most recent post. Since Garden may or may not have been freaking out since at least October I though it was about time to bring up the subject because freaking out since October sucks especially with academic obligations that may be extremely unforgiving. At least asking the therapist about medication at this point, a very broad class of medication, seems like the right thing to do. It's up to the therapist/doctors to answer that question.
posted by Procloeon at 4:35 PM on February 15, 2010


To be really clear: the place the line needs to be drawn is when an answerer gives a specific diagnosis or directly suggests a specific medication.

To be really clear: No. This comes up over and over again, so here we go: shelleycat, why should electronic conversations here at MeFi have higher standards than the millions of similar conversations ordinary people have every day over coffee, fences or the phone? Do you have a plan to police those as well?

Even saying x worked for me! doesn't mean shit

Damn, that's really going off the deep end. Of course different drugs can affect different people differently. That's why getting feedback from lots of people - say, on a group website - about how certain drugs affected them can be so useful. I learned so much from Usenet back when I was diagnosed with colitis in my late 20s; the wide range of experiences folks shared online about corticosteroids was eye-opening, and far more useful than the standard "these are the side effects" rap my doctor had given me.
posted by mediareport at 5:58 PM on February 15, 2010 [1 favorite]


lets just wait until someone sues the site.
posted by sgt.serenity at 6:34 PM on February 15, 2010


"There is no reason any Mefite should be recommending that any other Mefite take a medication under any circumstances whatsoever."

I think you should take a chill pill. ;)
posted by Jacqueline at 6:40 PM on February 15, 2010


sgt. serenity, as Mitheral already pointed out (we're recycling the chill pill jokes now, too :), AskMe's hardly the only forum where advice is shared, and so far no one's been able to dig up a case where the hosts of any advice forum have been sued - let alone successfully - for any kind of outcome from the free discussion they've made possible. If you know of any, it'd be informative to hear about them.
posted by mediareport at 6:46 PM on February 15, 2010


I have been offered aspirin dozens of times in my life, and have offered it -- and ibuprofen -- to dozens of people, whether from my purse or from my medicine cabinet, when people I'm with have complained about a headache.

My father is dangerously allergic to aspirin and ibuprofen. People offer it to him -- hell, it's slipped my mind and I've offered it to him myself. It's up to him to know that, and when people offer him aspirin, to pass or ask if they've got Tylenol instead.

What's interesting is that so many health professionals here are saying, "EVEN a doctor wouldn't do this on the Internet, so you definitely shouldn't." That's backward. A doctor has specific ethical obligations related to their profession that constrain their behavior. We non-doctors don't, so we actually have a lot more freedom in how we can answer questions.

And there's a reason for that: it's up to the receiver of the advice to give it a reasonable amount of credence. If the giver of advice is a doctor, the reasonable amount of credence goes way up. If the giver is a layperson, it's much lower.
posted by palliser at 7:41 PM on February 15, 2010 [3 favorites]


There is no reason any Mefite should be recommending that any other Mefite take a medication under any circumstances whatsoever.

I am so tired of hearing comments along these lines. Medicine is not really some mystical, closely held secret that only those in the kabal can recommend after reading our leaves. Seriously, if there is something we should al learn more about its our body and our biology. Many drugs move from more to less controlled as drug companies and the FDA see fit to let us actually take care of ourselves rather than vomiting all our money into the doctor's office. Just as I might recommend aspirn to someone who has a headache (and let them worry about their own allergy and well, their own being) I might recommend someone try a med that just happens to require a prescription too.

I feel the same way about the law, btw if you are wondering. Its our law! For us! Understand it and embrace it!

Just because someone has extra schooling does not automatically mean they have a better answer.
posted by stormygrey at 7:14 AM on February 16, 2010


Yeah, should have read, I just got mad and started typing and others basically said the same thing.
posted by stormygrey at 7:22 AM on February 16, 2010


Bad financial advice doesn't usually have the potential to send someone to the hospital, whereas bad aspirin advice actually might.

I'm resisting the urge to make a loan shark/kneecap quip here.

You continue to (willfully, I suspect) miss the point. There is lots of advice given in AskMe that will get your ass arrested, deported, sued, evicted, dumped, punched, slapped, and grod knows what else. Most of it, unlike prescription medication, doesn't require the person taking the advice to go through some sort of gatekeeper. So this endless hand-wringing over pharmacology is unbalanced - it's worrying about the deck chairs.

As far as the potential for lasting damage? I think you're under-estimating just how catastrophic the potential outcomes are for some of the legal and financial advice I see given here. I suspect that some people would have a hard time deciding if you offered them a choice between a bleeding disorder and eviction&homelessness.

People on Ask are either grown-ups responsible for themselves or not. The level of scrutiny and control you're asking for is, as Jess pointed out, simply undoable in the current system.
posted by phearlez at 7:31 AM on February 16, 2010


This is the third or fourth time I can remember having this debate right here in MeTa. The problem is that good answers to a health AskMe should nearly always be a recommendation for a sympathetic doctor, or a further source of creditable information.

Public opinion among the MeFi membership runs strongly the other way

There's also pretty much consensus between all the healthcare professionals who contribute, that the primary problem is making incorrect diagnoses, and then recommending meds to go along with them.

there's not some switch we can throw on askme that will make it not happen here.

I would support a system where anyone who posts a health AskMe should get a warning not to take advice without consulting a professional, and anyone who responds should get a warning not to make diagnoses on incomplete information. I agree with Cortex that it wouldn't change anything, because the lay consensus is that it's both acceptable and enjoyable to provide potentially dangerous advice.
posted by roofus at 7:54 AM on February 16, 2010


I would support a system where anyone who posts a systems-related AskMe should get a warning not to take advice without consulting a professional, and anyone who responds should get a warning not to make diagnoses on incomplete information. It wouldn't change anything, because the lay consensus is that it's both acceptable and enjoyable to provide potentially system-disabling advice.

Oh, wait, no. I don't support that.
posted by majick at 7:59 AM on February 16, 2010


A person is not their diagnosis, they are people, and reducing someone to a diagnosis is per the input of thousands of mental health consumers over the decades more damaging than helpful.

The damage isn't in the labelling in of itself, but in how people can reduce you to the symptoms of that label. Exuberance isn't allowed if people know your bipolar, its no longer considered in the normal range of emotion and, therein lies the rub. There are plenty of people who've been relieved to know what they're experiencing has a name, why there are so many questions along the lines of "what's wrong with me?" on the green. People want to know its not all in their heads, that its fixable if it is a problem or, that they're just like everyone else.

Put me in the camp that patients need to learn to be their own best advocates and, not sure why the onus should be on me to ensure that they're being honest with their doctor or, themselves. Or why, I need to qualify my answers like its a Yaz commercial (could they be any longer?) with all of its disclaimers.
posted by squeak at 8:00 AM on February 16, 2010


Oh, wait, no. I don't support that.

Why would you not support efforts to reduce potential harms? Other websites that give medical advice have disclaimers. This one comes from patientslikeme.com:

This Site Does Not Provide Medical Advice
ALL OF THE MATERIAL PROVIDED ON THE SITE, SUCH AS TEXT, TREATMENTS, DOSAGES, OUTCOMES, CHARTS, PATIENT PROFILES, GRAPHICS, PHOTOGRAPHS, IMAGES, ADVICE, MESSAGES, FORUM POSTINGS, AND ANY OTHER MATERIAL PROVIDED ON THE SITE ARE FOR INFORMATIONAL PURPOSES ONLY AND ARE NOT A SUBSTITUTE FOR PROFESSIONAL MEDICAL ADVICE OR TREATMENT. ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR OTHER QUALIFIED HEALTH PROVIDER WITH ANY QUESTIONS YOU MAY HAVE REGARDING YOUR HEALTH. NEVER DISREGARD PROFESSIONAL MEDICAL ADVICE OR DELAY IN SEEKING IT BECAUSE OF SOMETHING YOU HAVE READ ON THIS SITE.

IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY, CALL YOUR DOCTOR OR 911 IMMEDIATELY. PATIENTSLIKEME DOES NOT RECOMMEND OR ENDORSE ANY SPECIFIC TESTS, PHYSICIANS, PRODUCTS, PROCEDURES, OPINIONS, OR OTHER INFORMATION THAT MAY BE MENTIONED ON THE SITE. RELIANCE ON ANY INFORMATION PROVIDED BY PATIENTSLIKEME, BY PERSONS APPEARING ON THE SITE AT THE INVITATION OF PATIENTSLIKEME, OR BY OTHER MEMBERS IS SOLELY AT YOUR OWN RISK.
posted by roofus at 8:12 AM on February 16, 2010


We should swaddle everyone in batten.
posted by five fresh fish at 8:20 AM on February 16, 2010 [1 favorite]


roofus writes "Why would you not support efforts to reduce potential harms?"

Because the disclaimer would extend to a couple hundred pages and no one would read it. patientslikeme can do this because they have a very narrow focus. AskMe doesn't have that focus and would have to have disclaimers covering medical, law, plumbing, electrical wiring, financial, computing, pottery, etc. ad nauseum.

Or I guess we have a blanket warning on a splash screen when you load up AskMe:
WARNING: Contents may be harmful. Use may result in sadness, drama, financial loss, imprisonment, bodily injury or death.
posted by Mitheral at 9:08 AM on February 16, 2010


Why would you not support efforts to reduce potential harms? Other websites that give medical advice have disclaimers.

The only potential harm those disclaimers are designed to reduce is the potential harm to the balance sheet of patientslikeme.com should they get sued.

Actual people don't read that shit and take it to heart, and while I'm fine with mathowie protecting his ass in whatever legal small print manner he might feel is necessary and prudent, I'm glad this isn't the kind of site with multiple pages of legalese that no one will ever read as part of their registration process.
posted by jacquilynne at 9:25 AM on February 16, 2010 [1 favorite]


Pretending that relating personal experience is some kind of ethical swamp and that medical professionals are unerringly objective is hooey. There's one hell of a lot of gray area in diagnosis of mental illness and even more shades of gray in prescribing practices for same. Straightener, I take it you have a position in the "recovery" industry? You take the position that even discussion of medication outside the aegis of the medical profession is dangerous and should be censored? That is a fantastic position, but pretty predictable for someone with your professional interests.
posted by telstar at 9:25 AM on February 16, 2010


There's one hell of a lot of gray area in diagnosis of mental illness and even more shades of gray in prescribing practices for same.

That's precisely what I've been arguing (and The Straightener, too), and it's a reason not to bandy about specific diagnoses and medications. I'm really don't understand why it's more liberating to inscribe our thoughts, feelings, symptoms, and solutions within the broken official mental health nosology and pharmacopia.

Not incidentally, you don't seem to know what the "recovery model" of mental health treatment actually refers to, as its a movement that argues against the reductive medicalization of mental health treatment.
posted by OmieWise at 9:41 AM on February 16, 2010


I don't think we don't need a new system or ten pages of legalese. We have a system, we're soaking in it right now.

It's been suggested that everyone be a little more careful about how ardently and confidently we suggest specific medications and diagnoses. It's further been affirmed by the moderators that if suggestions in an AskMe question are off-base, it's okay to disagree or warn against the advice (as long as it's not a personal attack, of course.)

I think there are people who like the idea of Systems and Guidelines and Boxes To Check, and others who feel like that these things are Exceptionally Offensive, and a lot of us are somewhere in-between. But I find myself a little frustrated that these discussions always turn into complicated discussions of how/if to implement something special and the legal ramifications and inflammatory metaphors and so forth... but...discussion and moderation IS how these and related issues are handled around here. I think the system is working fine. A reminder doesn't mean that it's not.
posted by desuetude at 9:52 AM on February 16, 2010


Pretending that relating personal experience is some kind of ethical swamp and that medical professionals are unerringly objective is hooey.

telstar, did you read this comment by The Straightener? I'll quote the part that addresses any confusion about whether sharing personal experience is okay:
It would be a big difference if the thread was guided by the input of people in the community with anxiety disorders who were sharing their own experience with the poster in the hopes that perhaps some identification with that could provide some insight, clarity and maybe some motivation towards recovery and symptom management.
posted by desuetude at 9:58 AM on February 16, 2010


I don't know, I know we talk about the potential consequences of non-professionals giving health/legal advice (Lawsuits! Brain asplosion!) a lot, but I kind of agree that suggestions by non-psychiatrists with no direct knowledge of the OP can't do too much good (if the person is seeing a doc, they should be the one to recommend stuff) and could do harm.

It's just one story of a bad doc, but I actually know someone who, a few weeks ago, went into his new GP, told the GP about his history of opiate addiction and what worked for him in recovery before, and asked for prescriptions for suboxone, lithium, and Wellbutrin. This was the first time this doc had met this guy, the doc had no reason to think the guy hadn't done heroin, coke or anything else recently (he had), and he wrote the prescriptions on the patient's request (he "didn't want to" but he did).
posted by Pax at 10:24 AM on February 16, 2010


If one wants to prescribe in AskMe then one should at least acknowledge that there may be no gatekeeper, or even just a very busy and rushed gatekeeper, between one's prescription and the medication.

Or this.
posted by Pax at 10:29 AM on February 16, 2010


telstar, did you read this comment by The Straightener? I'll quote the part that addresses any confusion about whether sharing personal experience is okay:

It would be a big difference if the thread was guided by the input of people in the community with anxiety disorders who were sharing their own experience with the poster in the hopes that perhaps some identification with that could provide some insight, clarity and maybe some motivation towards recovery and symptom management.


And you know they're not, how exactly? Answers are going to take three forms: those that cite how they have that knowledge, those that say nothing, and those that explain (less honestly) that they pulled the information out of their ass.
  • Those that admit they're full of it - can be given the attention they deserve.
  • Those that say nothing - maybe they're knowledgeable people unwilling to share every little fact of their personal lives in order to provide advice... or they might be completely full of crap too
  • Those that cite their basis for knowledge - who may be spot on, might be honestly relating personal experience but are complete anomalies, or may be absolute perfect experts. And it's impossible to tell which.
Or in other words, nothing on AskMe - just like the rest of the internet - can simply be taken at face value. The best that we can hope for is some analysis from other perspectives and, hopefully, something approaching worthwhile citations that can be followed up on.

Is it possible people might find a way to get prescription meds without reasonable restraint from their doctors? Yep. Which is true whether they hear about drugs here, based on the BAZILLION commercials that run on television, information from WebMD they find via google, stuff they overhear at the grocery, ad infinitum.

Bad information is everywhere, not just Ask. If you have knowledge of a subject and loathe poor information in AskMe about it then there is a solution available to you: contribute, point out errors, and flag.

If you want this 0.01% of the internet to suddenly become a community-created source of information that doesn't have anything but perfectly sourced information? I think you're being unrealistic, holding Ask to an unreasonable standard, overlooking the value of what Ask actually manages to be, and, as the admins have told you, aren't going to get what you want.
posted by phearlez at 2:01 PM on February 16, 2010


"ALL OF THE MATERIAL PROVIDED ON THE SITE... LOUD LOUD LOUD BLAH LOUD LEGAL YAPPING NOISE NOISE LARGE MOSTLY IGNORED TEXT"

That's lawyer shit. I got tired and had to take a nap before the end of the first sentence. Shit, I still don't know what it says because it was A WALL OF CAPS BULLSHIT CYA DISCLAIMER. Humans won't read that, and it does nothing to reduce harm for the reader. It's all about having something to point to when someone get sued.

Seriously, I'm with you and fully on the side of reducing the harm morons with loud mouths can do. My donation check is in the mail and I'll be down on Thursday to volunteer to man the phones. But there's one line I won't cross and that's restraint of speech out of fear.
posted by majick at 4:17 PM on February 16, 2010 [3 favorites]


Yeah, that lawyer gibberish has everything to do with covering asses and nothing to do with helping people on AskMe.
posted by Justinian at 4:53 PM on February 16, 2010


To avoid inaccurate diagnoses, maybe we should also discourage vague "diagnose me on the basis of four paragraphs" questions. I have trouble realistically imagining that question ever going well. There was even a MetaTalk callout about it.
posted by salvia at 10:45 PM on February 16, 2010


Salvia: I think I'm just going to start guessing amyloidosis from now on.
posted by Justinian at 11:30 PM on February 16, 2010


I concur, Justinian; so many of these questions point to amyloidosis. A 14-day course of Xanax should clear it right up.
posted by salvia at 6:53 AM on February 17, 2010


No, akinetopsia.
posted by Pax at 7:16 AM on February 17, 2010


(Dammit, I should have concurred!)
posted by Pax at 7:16 AM on February 17, 2010


Perhaps instead it is Bardet-Biedl Syndrome? IANAD.
posted by salvia at 7:38 AM on February 17, 2010


It could be Lupus.
posted by Justinian at 12:30 PM on February 17, 2010 [1 favorite]


No it's Lyme disease. And also, it's definitely your thyroid, no matter how low the TSH.

Count me as the only healthcare professional here I guess, who is willing to be dismayed by the health-related advice I would judge to be "bad," without clamoring for a major policy change to how MeFi deals with this stuff. Here, as with advice in life, YMMV, and often you get what you pay for.

More alarming to me actually, is the seeking of anecdotal advice from people on the same therapy or with the same condition that everyone else seems to believe is kosher here. I feel like those questions should sometimes even be deleted, a priori. You know, when you ask the internet what their experience has been with prescription drug X, that is a pretty poor approach to sampling information, which in many cases will guarantee a biased response.
posted by drpynchon at 9:59 PM on February 17, 2010


Are you sure it's not fibromyalgia, drpynchon?
posted by Justinian at 1:20 AM on February 18, 2010


It's hysteria. The old-fashioned, Freudian type of hysteria.
posted by five fresh fish at 9:11 AM on February 18, 2010


It's never lupus
posted by patheral at 4:40 PM on February 18, 2010


Probably just self-allergic.
posted by Sys Rq at 10:00 PM on February 18, 2010


Hey, I have a happy medical AskMe story. A few years ago, my husband saw a recommendation on AskMe for a nose suction device for babies. We ordered one, and it worked great, much better than those useless bulb syringe thingies. So I told all my friends about them, and of course no one bought one because they're like $20 and the suction is delivered by you sucking in, which grossed them out. The other night, my friend had to take her 6-week-old to the ER, for the second time, for deep suctioning because he had RSV and was having trouble breathing. The next morning, she had this suctioning device overnighted to her. And yesterday, she called me up to say that the night before, her baby had had the breathing trouble again, and she'd just suctioned him out herself, and avoided yet another midnight trip to the ER. So thanks, AskMe, for that awesome medical advice!
posted by palliser at 6:38 AM on February 19, 2010


I've learned something from reading all of this and it was a good idea to call attention to this issue - albeit, in a shrill, slightly aggrandising manner.

I am on a few forums for women with pelvic pain and we can get rather casual about throwing hints, suggestions, symptom analysis and surgical options around. I guess it's on the understanding that we are sharing similar kinds of life stories and our histories give us cues to understand when others describe pains that we have had/have and that have been ignored/dismissed/trivialised or brutally treated by the medical establishment, to our significant detriment. I'd hate to see the body/health/mind questions disappear from AskMe offer alternatives for addressing issues, including how to interact with medicos effectively.
posted by honey-barbara at 9:27 AM on February 19, 2010


For the record, this Vitamin X discussion is done up in Extract, only funnier.
posted by Ambrosia Voyeur at 10:55 PM on February 22, 2010


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