These are troubling times for me as a physician and as a psychiatrist. They were even more so before I ran away… excuse me… took this… uh… sabbatical of mine.
None of this enormous mess we are all in together is brand new. We, as a nation, have grown into it rather slowly. Perhaps if this mess of a medical system had happened more suddenly it would have been easier to spot, easier for us all to perform the necessary pruning. Our entire country and all of us are buried to the neck in a quicksand that has been designed, bit by bit, over the decades. It’s deep.
It’s easy to lose energy and focus pointing at one another; pointing and blasting away. The easiest shots to make are at those closest by, the ones that are here, by your side.
It’s easy to lose power and momentum for movement toward meaningful change by imagining that psychiatry, psychiatrists and our patients are the only issues at stake; that we are the special case with special issues and that psychiatry is THE problem.
But I’m afraid we’re not the whole picture. We are important. Very much so. Every single person and their suffering is important. But psychiatry and it’s devolution to a pill model of care is only a ripple in this ocean of pill focused medical care we’re drowning in.
I keep coming back to this question, over and over:
“Can I, as one single individual physician, make any difference in where we, as a nation of about 311 million people, go from here? Can I make any difference with regard to finding ways to provide sensible and equitable healthcare for everyone?”
Although I’ve been gone from the practice of medicine for eight months at this point, I did spend almost a year back at work after I read “Anatomy of an Epidemic”. On the sunny afternoon I finished reading this book, I was certain I could not go back to work as a psychiatrist. Ever. It was a dark night of my soul in the middle of a brilliant sunny day.
I sat on the porch, watched the green trees and blue sky. I thought about many of the people I had treated with psychiatric medicines. I wondered how his life or her life would have been different if I had not given them medicines. I felt I needed to go away till I could get perspective on it all.
But the next morning a friend called and told me they were short handed at the clinic. He asked if I could come in and help out.
I thought, maybe there’s a way I can have a positive and transforming effect by working from inside the system.
I spent much of the next year saying “no” to a lot of requests for pills, saying “no” to dosage increases, explaining my concerns about the medicines to patients, colleagues and co-workers, reviewing and encouraging alternative approaches to managing symptoms.
Over that year I did not meet a single patient that did not come with a request for pills. My “no” and alternatives were met with “I’ll come back when the other doctor’s here” and “I don’t have time to exercise” and “I can’t afford therapy” and “If you don’t give me meds I’ll get kicked out” and “Alcohol’s not a problem for me” and “I haven’t used meth in two weeks and I still feel bad”. There was even one anxious pregnant woman who told me she’d already had a baby that required open heart surgery at birth. She demanded I give her the same medicine again. I did not. Patients did not thank me for protecting them from the effects of the drugs.
I’ve been happy to hear from all the people who do not want to take medicines and who want to taper to the lowest possible doses. You are not the ones I met at work. Not at all.
The system feels massive to me. The weight of the moving freight train of history embedded with clinical staff, funding managers and well marketed-to patients is bigger than me. I felt like I was bailing the ocean with a teaspoon. Galileo was jailed when he said the earth moved around the sun. I was simply overwhelmed by telling the truth every day I went to work.
I am here to use what I hope to be more powerful and wide-reaching tools than seeing patients, one by one; words on Robert Whitaker’s webzine.
I’ve known for a long time that words create the world. I mean this in both a practical sense and a philosophical one. I’ve written medical records and reports and requests for care authorization and disability claims. I understand how words on paper are used to define who and what we are. I also know that the words we speak and write and hear create our realities: angry words create an angry world and kind, loving words create a loving world.
No one who participates in this discussion comes to the table completely alone. And no one, alone, wields power sufficient to remake the practice of medicine into the cooperative two-way relationship and meaningful healing profession it could be.