September 15, 2011

Mark Foster, DO
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Dear Bob–

As I share with patients my new perspectives on the ineffectiveness and potential harm of psychotropic drugs, I have found that many, even most people, are receptive to the idea. I’d say that about 25% of people are enthusiastic about it: “Yeah, I don’t think those pills work anyway. Thanks for telling me.”; about 50% are somewhat receptive: “Really? That’s surprising, but it makes some sense. I’ll have to read more about it.”; and about 25% are highly skeptical of me, my suggestions, my motivations, my education, my sanity: “What do you mean they don’t work? Of course they work, doc. I’ll tell you what, don’t even try to take me off my pills. They changed my life. You’ll have to pry them out of my cold, dead hands.” (I actually had someone say this to me! I chose to let the obvious irony pass.)

This is all fine. Everybody needs to feel comfortable within their own paradigm, and I don’t expect everyone to agree with me, and I don’t claim to have any privileged vantage point of the truth. Patients can find plenty of other doctors willing to prescribe them brain-altering medications, no questions asked. But overall, I find these numbers encouraging, because they indicate that about 75% of people are at least willing to engage with a non-pharmaceutical paradigm. I’m convinced that most of those who do, who take the time to read the evidence and consider the implications, who glimpse who is actually benefiting from the current model (hint: not them), will find their way towards more holistic solutions for their mental distress. I think most people intuit that there is something fundamentally wrong, reductionist, dehumanizing, with the current system, and they’re looking for something better.

Which brings up a challenge all its own. Whenever someone comes to recognizes the harm and ineffectiveness of long-term psychotropic use, it invariably provokes this question: “Okay, pills aren’t the answer. So what else is there?”

Trying to answer this question, I’ve found, can be both frightening and exhilarating. My natural inclination–my sense of myself as a healer–makes me want to satisfy my patients’ expectations for quick and easy solutions. But I don’t offer those illusions anymore, and I resist anyone claiming to have the “One Best Solution” for everything–especially if they are making money off of selling it. Not having a prescription pad in hand, that seductive promise of a one-size-fits all guaranteed solution, makes me feel vulnerable, ineffective, unfulfilled–even if I’m simply being authentic and realistic.

I remain hopeful. Hope makes answering the question of “what else?” exhilarating, illuminating. There are so many non-drug recommendations to make! Many of them are amazingly simple solutions, things people already know but just aren’t doing effectively. I think the single most important thing I can help them with is the perspective shift, moving away from viewing mental and emotional distress as biological diseases worthy of eradication by harmful medicine, and towards an integrative approach that attempts to discern why the symptoms are occurring in the first place, what can be learned from them, what must change in order to restore a sense of wellness. This perspective is inherently hopeful, and embraces our bodies’ and minds’ intrinsic drive towards healing and wellness.

Below, I’m going to post a condensed list of a handout that I provide my patients. Some may find this list simplistic, and I agree that there are many instances when more aggressive interventions are indicated. But I believe the vast majority of people, if they put these suggestions into practice, would naturally, almost unavoidably, enjoy improved mental health and resilience. Not perfect everlasting happiness and ecstasy, mind you, but peace and purpose in their lives, a sense of wholeness.

Here’s the condensed list (an expanded list is available at this link, www.markfosterdo.blogspot.com). After you read the list, stick around, as I want to share a revealing case study.

Tried and True Methods For Achieving Mental and Emotional Well-being

(And none of them involve medications) by Dr. Mark Foster, DO 1) Daily exercise. (If you do nothing else on this list, do this.) • At least thirty minutes a day, everyday. 2) Eat healthy food • Start with five fresh fruits and veggies a day. 3) Daily sunshine • Get outside and enjoy nature. 4) Celebrate life • Grow plants, have pets, be around children. Appreciate the miracle of life. 5) Daily meditation • Breathe. “Spend less time as a human doing, and more time as a human being.” 6) Daily journaling • Be a hero as you write the story of your life! 7) Daily supportive conversations with a trusted friend • Seek out healthy, nurturing relationships. Be around people who inspire you. 8) Get plenty of sleep • Get eight hours of sleep a night, and try a twenty minute power nap after lunch. 9) Seek service opportunities • Forget about your own problems, and make a difference in somebody else’s life. 10) Fill your mind with positive messages • Read good books, watch great movies, listen to uplifting music, try a “news fast.” 11) Be creative • Release the artist within. Leave your unique mark on the world. 12) Keep a positive attitude • Hope for a better world and a better life. Never give up! 13) Integrate your feelings and thought patterns. • We feel and think things for a reason. What can you learn from your mental distress? What can you change so that you feel more at peace? Don’t become numb to life. Be fully alive and responsive to your emotions and thoughts. 14) Work with a trusted professional counselor, therapist or pastor. • An empathic therapist can be a powerful catalyst for healing. Find one that works for and with you.

That’s the list I hand my patients. It’s not a panacea–there is no such thing. But hopefully it gives them some concrete actions to take and helps them reframe their symptoms as opportunities for growth rather than diseases.

Last winter, I cared for a patient who was on seven psychotropics and not doing well. She was thirty-four years old and had been diagnosed with several conditions, including bipolar, adult ADD, depression, and borderline personality disorder. She was on an antipsychotic (Seroquel), an anxioloytic (Xanax), a mood stabilizer (Lithium), two antidepressants (Effexor and Wellbutrin), a stimulant (Ritalin), and a hypnotic (Ambien). (Just typing out that list makes me cringe.)

She had been on an ever-increasing regimen of pills since she was sixteen years old. She had gained a hundred pounds, developed diabetes, and most discouragingly, her mental health had steadily deteriorated. She came in to see me with her quiet and concerned husband in tow, wanting something to change. She felt like her psychiatrist didn’t do anything but refill her drugs, and since she trusted me as her primary care doctor, she sought my opinion. I told her I was worried about her being on this many medications and all their negative effects and interactions, and that we should carefully try to come down on the doses and stop the medicines one by one. She agreed that this would be wise, and then she, who had never in her adult life been without multiple brain-altering drugs in her system, asked me the expected question: “So what else can I do?”

For such a complex case, what could I recommended so that she could survive and thrive while coming off medications? Surely she needed more than my trite list of “lifestyle recommendations.” Not sure where else to start, I first recommended a slow taper off the medications, regular follow-ups with me and a therapist, a regular exercise program . . . and then I produced my handout. I asked her to read through it and tell me if there was anything she saw that she could work on. She said, “Yes.” I asked what caught her attention. She said, “All of it.”

I asked her to explain, and she said, “Well, I’m not doing any of this, and so I can work on all of it.”

We paused, and I went down the list with her, one by one.

“So, you’re not exercising?”

“Never.”

“Do you eat healthy?”

“I eat Cap’n Crunch, chips and soda pop all day long.” (Her husband nodded his head to confirm.)

“Do you go outside? Do you have a pet? Do you keep a journal? Do you have a regular bedtime? Do you listen to uplifting music?”

“No, no, and no . . .”

Basically, this woman–who is highly intelligent, college-educated, and currently on mental disability–has a life that consists entirely of sitting at home, eating chips, watching Jersey Shore, surfing the internet until 3 am and then sleeping to noon, listening to death metal, having no friends, yelling at her husband, not seeing a therapist . . . and believing all the while her thoughts and behaviors are the result of an uncontrollable biological disease that can only be partially controlled with seven medications. I felt very sad for her. This did not seem like a fulfilling life.

She received my handout–which appears to me to be nothing more than a compilation of common sense–as something of a revelation. She was doing exactly nothing it recommended. Who could expect to experience a sense of mental wellness when they were living in such unhealthy mental and physical conditions? No wonder she felt lousy, unhealthy, hopeless and purposeless. Like a lightbulb going off, here was somebody–finally–telling her that there may be another way to live that might help her to feel better. It certainly didn’t have to be a doctor telling her this, but as fate would have it, I was the one she had come to see for help.

Lousy, unhealthy, hopeless and purposeless: a lifetime of reductionist biopsychiatric care and drugs had led her to this undesirable place. It seems likely to me that, after having been labeled and drugged as a bright, confused and eccentric teen, she was never again looked upon by her psychiatrists as anything but a disease worthy of pharmacological restraint and quarantine.

I wish this story had a happy ending. She disregarded my advice and came off her meds too rapidly, became acutely manic, then psychotic, and wound back up in a psychiatric facility, back in the tentacles of the beast, told she was broken beyond repair, told to never stop taking her meds, the inference being that her life undrugged was simple too dangerous and unpredictable to be worth anything.

I was still her primary care doctor, but then I was fired, and I don’t know what has become of her. I hope she is doing well, meds or no meds.

I’m not so naive as to think my little handout can rescue all who are so lost within the system, so drugged and so distressed. But I am certain that lifestyle and perspective changes must be an essential component to achieving mental wellness. To try and achieve such a state without doing anything on that list? That’s a recipe for failure. If we’re taking someone whose mental status is in total disrepair, and if we have to start somewhere, start there, with lifestyle changes infused with a perspective of hope, an appeal to the mind and body’s ability to heal.

But don’t start with drugs. That’s a dead-end street for so many. That seductive prescription so often becomes an excuse to ignore the fundamental problems, precluding the self-awareness and healing that would occur if only we doctors offered patience, perspective, empathy . . . and got the heck out of the way.

Mark