My sabattical of last winter has spun off a second one. I remain uncertain of my role as a physician in a society which values pills over personal growth and change.
Last summer, unplugging my life from the “American dream” seemed in order. It’s not easy to make changes with chains and weights in place. It’s not easy to think, decide and move with the financial shackles that are the bones of everyday life.
I sold the long-time family home. I gave away our accumulated possessions. Now I have more freedom to think and work on personal projects. It was a busy and difficult summer. I hope yours was better.
A line from a song I learned in elementary school comes to mind here:
“Freedom isn’t free.”
Now, I get to spend more time watching and walking, thinking and writing. The more I watch and walk, the more I see that things are interconnected, enmeshed together, part of a larger unity.
Please bear with me through another of my rambles. They are connected, as all things and all of us are.
However much I would like to think that the issues in the practice of medicine are isolated to medicine, however much easier the cure if the problem was limited to thoughtless and greedy psychiatrists prescribing cash-cow drugs to innocent patients, I cannot, personally, view the situation as such.
Yesterday, I thanked a bicyclist for riding his bike instead of adding one more car to the polluting mass of cars at the intersection where we met. His panniers and basket were loaded, his backpack filled. He seemed startled when I thanked him for not adding one more car to the pollution. The unending stream of cars coughed out fumes into the five-by-five lane intersection beside us. My husband and I were on foot, one mile into our one-point-two mile walk to a grocery store. Before he rode away, the cyclist thanked us for walking.
We picked this area because it is more walkable than much of America. A lot of our country was intentionally designed to be dependent on the automobile for everyday life. Collusion among industrialists, particularly car manufacturers and fuel producers, led to the destruction of other transportation systems. Over time, our country’s development has continued in this car-dependent fashion. For most Americans, there is no way to get from home to work or to buy food without a car.
I talk to people I meet about global warming, pollution and the financial and health costs of automobiles. According to the CDC, the number one cause of death among all Americans ages 5 to 34 are car crashes. In response, I get a nod of agreement, then a smile and a shrug.
“I know. But it’s just the way things are.”
If anything else were cutting short the lives of so many innocent young people, we would be taking to the streets in protest. Wouldn’t we?
But it’s just the way things are.
Recently, I had a conversation with the medical director of a psychiatric clinic in another town. Since prescribing drugs is now the entire job description of psychiatrists (and most doctors today), our conversation turned toward the prescribing of drugs.
I expressed my professional concerns about “polypharmacy” (the increasingly common habit of rapidly prescribing multiple drugs to one person), the narrowed role of doctors in the practice of medicine, the loss of other skill sets in psychiatry and my concerns about the toxicities of drugs.
I got agreement, then shrugs and smiles.
“It’s just the way things are. We have to work with it.”
Then I raised my concern about the money issues, how the tactics used in promoting drugs could be leading us doctors astray. I mentioned the drug money that pays for both undergraduate and post-graduate medical education, the drug money funding research, the drug money at the FDA level funding the drug approval process.
His expression became worried.
Because I was trained before the takeover of the psychiatric profession by psychopharmacologists, I’m a practiced observer of human non-verbal communications. I was able to read the thought bubble that hung over his head.
“Suspicious kook. Troublemaker.”
I’ve learned to tame back the rhetoric when I get that “look”. Otherwise, I lose my audience altogether.
The air pollution where I am now is thick along the beach on a sunny weekend. If I walk on those afternoons, I cough for two days after. This can’t be good.
When I mention air pollution to people that get out of their cars to look at the water, I get that look. I’m told that the air is fine here, that American cars run clean, that we’re protected by federal regulations.
Two days ago, I was reminded by a visitor that the U.S. blocks the import of many European-made cars. He would like to buy a German vehicle that is not allowed in this country.
“Of course we do,” I said. “The government blocks imported cars to protect our auto industry.”
I smiled and nodded. I thought we were on mutually agreeable territory.
“We have stricter safety and pollution standards,” he insisted. “Europe has much worse pollution than we do.”
“Funny,” I said. “When I was there last year I didn’t see the orange haze over any town I visited. My eyes didn’t burn. Walking in town didn’t make me cough.”
We had little to say after this. He got back in his big truck and drove away, alone. And he left a swath of diesel fumes behind for me to breathe.
The air is fine, sealed inside the air-conditioned cab of a truck.
I tell people of my concerns about the over-use of psychiatric drugs. I fret aloud about their known and unknown toxicities. I talk about the financial conflicts of interest happening between pharmaceutical companies and government agencies, medical schools and researchers.
Folks nod and agree. Poison drugs are bad. Greed sucks.
But one friend of mine whispered this to me:
“I agree with everything you say. Just don’t take my antidepressants away from me.”
Thanks for reading, thinking and writing.
All the best.
Necessary Phoenix: Can one physician help heal the practice of medicine? After two and a half decades of work as a psychiatrist in private practice, community clinics and inpatient units, Dr. Keys shares her personal perspectives on the devolution of medical care and the needed resurrection.