An old friend suggested to me that doctors need support after hearing the messages in Robert Whitaker’s book, “Anatomy of an Epidemic”. I agree. Doctors need support.
My friend thinks I’m one who can provide it through my writing. “About a hundred doctors are here in Medford, listening to Bob speak,” he wrote to me last weekend.
I imagine the feelings in that room full of doctors. Could they be like mine when I read this book? Could they feel very different from me? Perhaps they feel even more so. Maybe some feel so much more so as to need to slam and lock the door on it all. After all, they have a lot on their plates, big complicated jobs to do. And it’s not like there’s another doctor to step up and see their patients while they work this out for themselves.
Probably I’m not the best person to provide support for the complicated set of thoughts and feelings that can and do emerge inside doctors when they come up against this information. I regularly feel overwhelmed by the thousands of cars I see here in the Bay area, each with one driver, while we wage wars on multiple fronts and the polar ice caps melt to leave the bears to drown.
I’m on a sabattical right now, in part because of my own personal reactions to the fall of my walls of denial with regard to the safety and efficacy of psychiatric medicines. People celebrated when the Berlin wall came down. But then there were difficult and complicated adjustments. I’m more fortunate than most. I had the freedom to walk away for a while, so I’m probably not the best person to provide support to those hard-working folks still in the trenches.
They are likely harder working, better students and more dedicated physicians than I have ever been. I’ve always kept my professional life to part time, allowed space for family and relationships and introspection about the meaning of it all. If I felt bad after reading the unexpected truths in this book, and I did feel very very bad, how must those physicians that are exhausted from long hours and years of the pressured high speed jog of modern medical practice feel? I can only imagine. I can empathize. I can listen. But I can never burrow inside the tunnels of another doctor’s head and know exactly how he feels.
I found this book in the new nonfiction area of my neighborhood library. It was the random pickup of a stranger, not planned at all. I like to read. I had no idea what Robert Whitaker would reveal to me about modern pharmaceutical products, my professional organizations, the FDA drug approval process, medical education or myself as a physician. In all my years of thought and learning I somehow missed big swaths of financial conflicts of interest from the top to the bottom. I was too preoccupied with doing the best I could to help every patient that walked in my door.
The river channel of my focus has been too increasingly crammed with debris and flood waters to grasp the big picture. Five new patients today. New drugs. Doubts as side effects emerge. It seems to me that when drugs finally make it to the affordable four dollar lists they’re found lacking. They all start out so hot and new and marvelous and expensive. Check labs. Measure girth. Document movements. Review risk benefit analysis with the patient. More new medicines to layer over old medicines. Glossy ads in professional journals. Type this report. Sign this. Fill out that. Insurance company “care managers” questioning, ordaining, disallowing. This patient read about it on the internet. That patient on TV sounds just like me, Doctor Keys. It’s what my mother takes. If you don’t give it to me I’ll go somewhere else and get it. Another patient and another patient and another patient. Double booking. Triple booking. The meds, the meds, always the meds. Refills all day long.
The patient sits there. This endless stream of my fellow humans sits there. Another and another, each with his own personal sufferings, his own story to tell me. Each wants to be heard. Each one wants to feel happy and suffer less. And I want that for him as well. Underneath all the noise of modern medical practice, I love my patients. I care. I want the best for them.
I thought I was helping when I passed out the medicines. I really did. Now I’m not so certain. The “research” I relied upon has a few flaws. Maybe the meds don’t work as well as we thought or they don’t work in the ways we were told. And the risks. Maybe those are bigger, more long lasting than we initially were taught. After all, drug research is short term and done with small, hand-selected populations. And, oh yes, the one who pays for the research decides how to play the results. Good. Great. Not really.
I used to think of myself as one that could cut through the crap of the advertising conglomerate and find the truth. I muted advertisements on television even before I turned off broadcast media in our home ten years ago. I won’t even listen to public radio. I gave it up. I thought I was one of the last clear thinkers left in our media-seduced, materialistic nation. I was so cool, not a little grandiose. But this is part of the ad campaigns, the thought that I am more immune than the next guy to the brainwashing effects of pervasive marketing strategies, that I can still make good choices.
When I got the bigger picture, after I read Robert Whitaker’s book, my professional world view imploded. With it went my personal image of me as a clear thinker, a careful skeptic and a helping professional. This sucks. Big time.
It turns out I have been a dupe, parroting lines from pharmaceutical marketing literature. “Seritonergic discontinuation syndrome”, “chemical imbalance”, “safety” and “efficacy”. I’ve been so busy studying the fine print in the drug bible, memorizing dosing schedules and side-effect profiles that I missed the big picture of the money and control chains that are so nicely elucidated in Mr. Whitaker’s book; drug dollars that fund drug approval at the FDA level, drug dollars that fund “medical education”, drug dollars that fund professional lobby organizations, drug dollars that fund and control “medical research” and the drug dollars that fund “patient support networks”. This is way beyond coffee mugs and pens.
I was so busy fighting for my patients’ “rights” to have the drugs that I missed the gradual death of all non-pharmacologic treatment approaches. I didn’t miss the dissolution of the doctor-patient relationship. I watched it go down the drain. I had been made powerless to stop it in this brave new world where all patient care comes at the bidding of third parties with stock dividends and tax payers to mind.
I am so not the right person to offer support to my disenchanted colleagues in the medical profession. I am certain all of us came to this party for better reasons than those that keep us here today. And I have slipped away, at least for a while, to ponder what the heck this means to me as a doctor, as a mother, as an American citizen.
I honestly have no idea what to do next.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.