The Shame Game of “Patient Responsibility”

Elliot Goldberg, LCSW
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On one hand the use of prescription drugs in mental health treatment has been compared to insulin for the diabetic. You never hear about the other hand. If tens of thousands or more diabetic patients were dying annually as a result of insulin use (as is the case with overall prescription drug use) all kinds of questions would be asked. When it comes to prescriptions, their producers and suppliers, the drugs are predominantly protected from scrutiny. The risks of adverse events, side effects and death are shuffled under the blanket like a lonely gorilla in the living room.

My previous blog post discussed Leslie Carter, the sister of a famous boy band pop musician, who was discovered dead with three prescription drug bottles by her side.  The closing thoughts in that post contemplated whether a little known celebrity would be forgotten and whether we would discover the truth about what and/or who caused her death. Of course we all now know that she has been forgotten, overshadowed by the eerily similar death one week later of the towering famous singer Whitney Houston. Houston was found with no less than six prescriptions in her hotel room and did not drown as was initially speculated. Xanax was the common prescription in the two occurrences. In death, as in her childhood family, Leslie was vanished by someone with more fame. Leslie Carter, as it turns out, represents the many hundreds of thousands of non-famous people who span the spectrum of acute, chronic and fatal illnesses that have been potentially caused by the misuse of prescription medicines. All of these victims may have been obscured but they must not be forgotten.

In a New York Times op-ed  piece (2/16/2012) titled “Patients Must Also Be Responsible,” which followed Whitney Houston’s death, Carol J. Boyd a professor at the University of Michigan School of Nursing proposes four possible solutions to the prescription drug epidemic:

1) Providers should reconsider their refill and prescribing practices
2) Patients should be advised on proper use and misuses of prescriptions
3) Policy makers should create and enhance monitoring systems to track the trail of doctor/patient prescribing patterns
4) A system should be implemented for the safe and efficient disposal of unused prescriptions

 

The article closes with this statement…….”Patients must change too. Let us not forget to use the medicine as advised. We must all take responsibility.” When you read about the government’s response to the overwhelming prescription drug problem this refrain is heard over and over again. One can’t help but wonder, however, what is missing from this sensible sounding analysis of the problem?

An essential ingredient in the Get Off Prescription Drugs outpatient rehab program is the family/social network component. In it friends and family are solicited as collaborators in a two-fold effort. It is the antithesis of the humiliation and confrontation that is widely used for intervention and in rehab treatment. Instead it is, first, an honest and authentic provision of love and support that enables the beast of addiction and withdrawal to be managed, fought, and defeated. Secondly, it is an opportunity to explore the underlying issues reflected in key relationships that often involve trauma, neglect or abuse. Unlike traditional therapy it is a celebration of respect and kindness with no one expert. The clinician serves as a navigator toward the end goal of recovery and a return to self for clients.

One of the great grandfathers of Family Therapy was an inspirational clinician named Carl Whitaker. He often told a story about how when he was a child his mother held him on her knee and whispered to him how much benefit she had received from her psychiatrist and her therapy. Whitaker (Carl) went on to conclude that this impression became an imprint for him and lead him to the path of Family Psychotherapy. One of his most frequently cited quotes is the following: “Shame occurs when you haven’t been able to get away with the ‘who’ you want people to think you are.”

If you ponder this quote about shame as a trickle down metaphor, it can easily be applied to the prescription drug misuser who has at once been fooling him/herself and those around him/her, and at the same time has been fooled by the medical establishment who had a sworn duty not to harm. Even the user on the street is ultimately supplied by a medical provider. The misadventure of harmful prescription drug treatment is beginning to unravel and the pharmaceutical companies and their providers are being exposed for who they really are.

Another of Carl Whitaker’s famous quotes from mental health Family Therapy is this: “The problem is you have a disease, but the disease is abnormal integrity, loyalty to a view of the world that the schizophrenic is willing to stake his life on.” This statement was prophetic and right on the money today. Because it is precisely the abnormal integrity of the medical establishment and the bio-psychiatric/medical paradigm that has most probably lead to the epidemic chronification and potential loss of life referenced above. Harm for profit is truly something to be ashamed of.

The evaluation that we are all responsible at some level for harmful prescription drug use takes out of account the overpowering influences of marketing, conflicts of interest, positions of medical trust, corporate lobbies and most significantly the drugs themselves. Just like in family treatment, the identified patient is not responsible for the abuses of power that came before, only the recovery to come. Until truth is spoken to power, however, the healing sputters and has a hard time getting off the ground.

The Canadian news media published last week (2/23/2012) an article titled “No Magic Bullet to Fight Prescription Drug Misuse.”  What an ironic headline given the fact that a magic bullet is exactly what the drug companies promised in the first place in order to fight maladies. The Canadian Centre for Substance Abuse organized a national dialogue and had this to say about responsibility: “We’re pulling together a comprehensive, pan-Canadian strategy to address prescription drug misuse. It will be multi-faceted. Everybody is accountable. We cannot simply enforce our way out of this. We cannot simply point fingers at providers and physicians. We all have to play a role, including the patient.”

Nowhere does the Canadian article (or anyone else in the media for that matter) mention the pharmaceutical companies that made provision to the providers who in turn provided to the trusting patient. Talk about a glaring omission.

This raises two questions for consideration regarding responsibility for harmful prescription drug use: a) if we can’t hold the pharmaceutical companies and their providers accountable first how successful can any nationalized effort be in curbing the epidemic? And b) are we not re-shaming the patient, the victim betrayed by a trust sworn to do no harm, who should only be responsible for the recovery from that harm?

The moral imperative, which restores us to a sincere integrity, is found in the identification of the abuses of power and the positioning of our sympathies. To echo my prior blog post, mine lie with Leslie Carter, Whitney Houston, all others made ill by prescription drugs, and their loved ones who were turned into collateral damage.

 

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