Moderation, Please?

In my very first post here on Shrink Rap News, I talked about The Accessible Psychiatry Project that Anne Hanson, Steve Daviss and I have been working on for nearly 6 years now. The most interactive component of this project has been our Shrink Rap blog, now with over 1,640 posts.

If you’ve ever thought about starting a psychiatry blog, let me tell you that it’s a very interesting experience. We started with the idea that we would write about our work and converse with other psychiatrists, “a blog by psychiatrist, for psychiatrists,” or so our masthead reads. We soon discovered that with an open, unmoderated comment section, and no requirement for identification or registration, our audience of readers was not limited to psychiatrists. Our readers included other mental health professionals, physicians, and nurses in a variety of fields, people from all over the world comparing notes on mental health care policy, and many people who’ve been treated for psychiatric disorders and have a lot to say about their treatments.

Why would we want to interact with patients on a blog – for free, and after hours, no less – when we talk to patients all day? That’s a really good question, one that I still don’t have a complete answer for. What I can say is that the experience has been surprisingly enlightening, rewarding, and for the vast majority of the time, fun. It’s added an entirely new dimension to our work as psychiatrists, and there is something gratifying about a discussion that includes intelligent, articulate people from all over the world, and the playing field for the conversations is more level than the conversations that are had in the context of a doctor-patient interaction.

We’ll write a blog post and other mental health care providers will come and comment about their experiences, similar or not so similar. Patients come and talk about the same event from the perspective of the patient. They may share their affection for their doctors, or talk about what their psychiatrist has done in similar situations, and they tell their stories with a poignancy that is sometimes quite moving. With time, they’ve come to relate to us, the bloggers, in interesting ways and they interact with the other commenters on the blog, sometimes offering support, and sometimes being very critical. The relationships themselves can be quite complex – one lovely nurse has sent us links to YouTube videos of her musical performances as well as to a video she made demonstrating the deep brain stimulator she’d had placed for intractable migraines. Of course, I didn’t have to watch, but I found it fascinating.

Many of the comments we’ve gotten over the year have been warm and supportive. Some have expressed appreciation for our work, and that is always nice. But one of the interesting aspects of a psychiatry blog is that visitors are not all friendly, and some come to discuss the difficulties they’ve had with their care and the criticisms they have about the delivery of psychiatric treatments.

As a clinical psychiatrist, my patients come because they want help and they understand that I am on their side. Usually, they are happy to see me, and if not, I suppose they cancel their appointments, but very few patients come to be angry with me. Not so on Shrink Rap. Readers may come to tell stories of how they’ve been wronged by psychiatrists and the treatments we offer. Many are angry that they’ve had horrible side effects to medications, suffered memory loss during ECT, been humiliated by involuntary hospitalizations, or simply been addressed with unkind and insensitive words in a way that leaves them wounded.

After years of visiting psychiatry blogs, I’m well aware that this is not unique to Shrink Rap, but that all psychiatry blogs attract a cohort of injured readers. They can be a harsh with their words towards us and towards the other commenters. In addition, there are a subgroup of commenters who are known on the Internet as “trolls.” Wikipedia defines a troll as, “someone who posts inflammatory, extraneous, or off-topic messages in an online community.” Trolls often have a message they are trying to get across, and on psychiatry blogs these include anti-psychiatry sentiments, for example the idea that medications are harmful for everyone, or ECT should never be used.

Many psychiatry blogs, including this one on Clinical Psychiatry News, discourage these sentiments by requiring registration with identifying information, and by moderating the comments and only posting those the blog administrator wants made public. On Shrink Rap, we have gone back and forth on this, and for the most part, we’ve allowed anonymous, un-moderated comments. We’ve felt that it allows for a more open on-line discussion, and that when comments are moderated it leaves us vulnerable to the accusation that psychiatrists are only wiling to acknowledge information that supports their way of thinking and are unwilling to hear criticisms of their profession. At the same time, it’s been a difficult line to tread, as strident commenters sometimes scare away those who would like to express opposing opinions. Last week, for the second time in Shrink Rap’s history, we began moderating comments – hopefully only for a brief time.

Have you ever considered starting a blog? Have you thought about whether you’d take all commenters or filter out the voices that are hard to hear? There many medical blogs on the Internet, but surprisingly few psychiatrist-run blogs. The Internet remains a place where mainstream psychiatry and the good it may do, get lost in a loud avalanche of sentiments that cover us in mud.

<[QM]>—Dinah Miller, M.D.

If you would like to comment on this article here, please register with Clinical Psychiatry News. If you are already registered, please log in to comment.

Dr. Miller is the co-author of Shrink Rap: Three Psychiatrists Explain Their Work, recently released by Johns Hopkins University Press.

In my very first post here on Shrink Rap News, I talked about The Accessible Psychiatry Project that Anne Hanson, Steve Daviss and I have been working on for nearly 6 years now. The most interactive component of this project has been our Shrink Rap blog, now with over 1,640 posts.

If you’ve ever thought about starting a psychiatry blog, let me tell you that it’s a very interesting experience. We started with the idea that we would write about our work and converse with other psychiatrists, “a blog by psychiatrist, for psychiatrists,” or so our masthead reads. We soon discovered that with an open, unmoderated comment section, and no requirement for identification or registration, our audience of readers was not limited to psychiatrists. Our readers included other mental health professionals, physicians, and nurses in a variety of fields, people from all over the world comparing notes on mental health care policy, and many people who’ve been treated for psychiatric disorders and have a lot to say about their treatments.

Why would we want to interact with patients on a blog – for free, and after hours, no less – when we talk to patients all day? That’s a really good question, one that I still don’t have a complete answer for. What I can say is that the experience has been surprisingly enlightening, rewarding, and for the vast majority of the time, fun. It’s added an entirely new dimension to our work as psychiatrists, and there is something gratifying about a discussion that includes intelligent, articulate people from all over the world, and the playing field for the conversations is more level than the conversations that are had in the context of a doctor-patient interaction.

We’ll write a blog post and other mental health care providers will come and comment about their experiences, similar or not so similar. Patients come and talk about the same event from the perspective of the patient. They may share their affection for their doctors, or talk about what their psychiatrist has done in similar situations, and they tell their stories with a poignancy that is sometimes quite moving. With time, they’ve come to relate to us, the bloggers, in interesting ways and they interact with the other commenters on the blog, sometimes offering support, and sometimes being very critical. The relationships themselves can be quite complex – one lovely nurse has sent us links to YouTube videos of her musical performances as well as to a video she made demonstrating the deep brain stimulator she’d had placed for intractable migraines. Of course, I didn’t have to watch, but I found it fascinating.

Many of the comments we’ve gotten over the year have been warm and supportive. Some have expressed appreciation for our work, and that is always nice. But one of the interesting aspects of a psychiatry blog is that visitors are not all friendly, and some come to discuss the difficulties they’ve had with their care and the criticisms they have about the delivery of psychiatric treatments.

As a clinical psychiatrist, my patients come because they want help and they understand that I am on their side. Usually, they are happy to see me, and if not, I suppose they cancel their appointments, but very few patients come to be angry with me. Not so on Shrink Rap. Readers may come to tell stories of how they’ve been wronged by psychiatrists and the treatments we offer. Many are angry that they’ve had horrible side effects to medications, suffered memory loss during ECT, been humiliated by involuntary hospitalizations, or simply been addressed with unkind and insensitive words in a way that leaves them wounded.

After years of visiting psychiatry blogs, I’m well aware that this is not unique to Shrink Rap, but that all psychiatry blogs attract a cohort of injured readers. They can be a harsh with their words towards us and towards the other commenters. In addition, there are a subgroup of commenters who are known on the Internet as “trolls.” Wikipedia defines a troll as, “someone who posts inflammatory, extraneous, or off-topic messages in an online community.” Trolls often have a message they are trying to get across, and on psychiatry blogs these include anti-psychiatry sentiments, for example the idea that medications are harmful for everyone, or ECT should never be used.

Many psychiatry blogs, including this one on Clinical Psychiatry News, discourage these sentiments by requiring registration with identifying information, and by moderating the comments and only posting those the blog administrator wants made public. On Shrink Rap, we have gone back and forth on this, and for the most part, we’ve allowed anonymous, un-moderated comments. We’ve felt that it allows for a more open on-line discussion, and that when comments are moderated it leaves us vulnerable to the accusation that psychiatrists are only wiling to acknowledge information that supports their way of thinking and are unwilling to hear criticisms of their profession. At the same time, it’s been a difficult line to tread, as strident commenters sometimes scare away those who would like to express opposing opinions. Last week, for the second time in Shrink Rap’s history, we began moderating comments – hopefully only for a brief time.

Have you ever considered starting a blog? Have you thought about whether you’d take all commenters or filter out the voices that are hard to hear? There many medical blogs on the Internet, but surprisingly few psychiatrist-run blogs. The Internet remains a place where mainstream psychiatry and the good it may do, get lost in a loud avalanche of sentiments that cover us in mud.

<[QM]>—Dinah Miller, M.D.

If you would like to comment on this article here, please register with Clinical Psychiatry News. If you are already registered, please log in to comment.

Dr. Miller is the co-author of Shrink Rap: Three Psychiatrists Explain Their Work, recently released by Johns Hopkins University Press.

In my very first post here on Shrink Rap News, I talked about The Accessible Psychiatry Project that Anne Hanson, Steve Daviss and I have been working on for nearly 6 years now. The most interactive component of this project has been our Shrink Rap blog, now with over 1,640 posts.

If you’ve ever thought about starting a psychiatry blog, let me tell you that it’s a very interesting experience. We started with the idea that we would write about our work and converse with other psychiatrists, “a blog by psychiatrist, for psychiatrists,” or so our masthead reads. We soon discovered that with an open, unmoderated comment section, and no requirement for identification or registration, our audience of readers was not limited to psychiatrists. Our readers included other mental health professionals, physicians, and nurses in a variety of fields, people from all over the world comparing notes on mental health care policy, and many people who’ve been treated for psychiatric disorders and have a lot to say about their treatments.

Why would we want to interact with patients on a blog – for free, and after hours, no less – when we talk to patients all day? That’s a really good question, one that I still don’t have a complete answer for. What I can say is that the experience has been surprisingly enlightening, rewarding, and for the vast majority of the time, fun. It’s added an entirely new dimension to our work as psychiatrists, and there is something gratifying about a discussion that includes intelligent, articulate people from all over the world, and the playing field for the conversations is more level than the conversations that are had in the context of a doctor-patient interaction.

We’ll write a blog post and other mental health care providers will come and comment about their experiences, similar or not so similar. Patients come and talk about the same event from the perspective of the patient. They may share their affection for their doctors, or talk about what their psychiatrist has done in similar situations, and they tell their stories with a poignancy that is sometimes quite moving. With time, they’ve come to relate to us, the bloggers, in interesting ways and they interact with the other commenters on the blog, sometimes offering support, and sometimes being very critical. The relationships themselves can be quite complex – one lovely nurse has sent us links to YouTube videos of her musical performances as well as to a video she made demonstrating the deep brain stimulator she’d had placed for intractable migraines. Of course, I didn’t have to watch, but I found it fascinating.

Many of the comments we’ve gotten over the year have been warm and supportive. Some have expressed appreciation for our work, and that is always nice. But one of the interesting aspects of a psychiatry blog is that visitors are not all friendly, and some come to discuss the difficulties they’ve had with their care and the criticisms they have about the delivery of psychiatric treatments.

As a clinical psychiatrist, my patients come because they want help and they understand that I am on their side. Usually, they are happy to see me, and if not, I suppose they cancel their appointments, but very few patients come to be angry with me. Not so on Shrink Rap. Readers may come to tell stories of how they’ve been wronged by psychiatrists and the treatments we offer. Many are angry that they’ve had horrible side effects to medications, suffered memory loss during ECT, been humiliated by involuntary hospitalizations, or simply been addressed with unkind and insensitive words in a way that leaves them wounded.

After years of visiting psychiatry blogs, I’m well aware that this is not unique to Shrink Rap, but that all psychiatry blogs attract a cohort of injured readers. They can be a harsh with their words towards us and towards the other commenters. In addition, there are a subgroup of commenters who are known on the Internet as “trolls.” Wikipedia defines a troll as, “someone who posts inflammatory, extraneous, or off-topic messages in an online community.” Trolls often have a message they are trying to get across, and on psychiatry blogs these include anti-psychiatry sentiments, for example the idea that medications are harmful for everyone, or ECT should never be used.

Many psychiatry blogs, including this one on Clinical Psychiatry News, discourage these sentiments by requiring registration with identifying information, and by moderating the comments and only posting those the blog administrator wants made public. On Shrink Rap, we have gone back and forth on this, and for the most part, we’ve allowed anonymous, un-moderated comments. We’ve felt that it allows for a more open on-line discussion, and that when comments are moderated it leaves us vulnerable to the accusation that psychiatrists are only wiling to acknowledge information that supports their way of thinking and are unwilling to hear criticisms of their profession. At the same time, it’s been a difficult line to tread, as strident commenters sometimes scare away those who would like to express opposing opinions. Last week, for the second time in Shrink Rap’s history, we began moderating comments – hopefully only for a brief time.

Have you ever considered starting a blog? Have you thought about whether you’d take all commenters or filter out the voices that are hard to hear? There many medical blogs on the Internet, but surprisingly few psychiatrist-run blogs. The Internet remains a place where mainstream psychiatry and the good it may do, get lost in a loud avalanche of sentiments that cover us in mud.

<[QM]>—Dinah Miller, M.D.

If you would like to comment on this article here, please register with Clinical Psychiatry News. If you are already registered, please log in to comment.

Dr. Miller is the co-author of Shrink Rap: Three Psychiatrists Explain Their Work, recently released by Johns Hopkins University Press.