Letters From the Front Lines

Mark Foster, DO
4
96
Dear Bob:
Saw a young man recently, early 30s, who wanted help withdrawing from benzodiazepines.
He had been on escalating doses of Xanax for two years.  The Xanax had been prescribed for panic attacks that began after he was placed on Wellbutrin.  The Wellbutrin had been prescribed when he became depressed while on high doses of narcotic pain medicine.  And the narcotics had been prescribed starting four years previously after he injured his back at work.
He had no psychiatric history prior to the back injury.  For four years now, he has been cycled through drug after drug by well-meaning primary care physicians.  It’s easy to see in retrospect that each drug was treating, at least in part, the side effect of another drug, as he built up a tolerance to each until he reached a maximum dose.
And here’s the thing:  he’s on all of these drugs, and he still has back pain . . . but it’s worse now.  He still has depression, but worse.  He still has panic atacks, but worse.
He can’t hold a job, he can’t engage in his marriage, he can’t function in his life.  He’s addicted and he knows it.  Getting worse with polypharmaacy, not better.
I started seeing him when he had reached the end of his rope.  Luckily, he has enough residual self-awareness and inner resources to recognize that he was headed down a dead-end street.  He didn’t like that ending, so he sought me out to change the script, so to speak.  He and I have got a plan, and we’ve started to decrease doses and stop medications one at a time, doing our best to replace the drugs’ effects with healthy habits and support systems.  I have high hopes that he will do well.
Yet it is stunning and dismaying how frequently this occurs.  In this whole chain of events, none of the principal actors–doctors and patient–are unscrupulous or looking to have a bad outcome.  They’re just people, trying to do their best, but with the limited horizon afforded by a deeply flawed system.
Are there bad guys here?  I don’t know.  Maybe some fat cats sitting in corporate offices of Big Pharma somewhere.  Maybe some academic psychiatrists who take money to promote misinformation and misdirection.  But I don’t know any of those types.  I just know people like my patient and like myself who are trying to sweat it out in the clinics everyday and make sense of the tangled mess of science, economics, ethics, and human behavior that’s been handed us.
System failure is what this is.  Starts at the top.  Starts where the money is.  Filters down to the rest of us, and in the name of healing, causes so much unnecessary harm.
Maybe it’s time to get a new system.
Mark

Editor’s note: These letters are selected from an exchange that Dr. Foster and Robert Whitaker have had since he read Anatomy of an Epidemic. They describe his interactions with his patients, and his changing thoughts about the prescribing of psychiatric medications. In all of these letters, the specific patient situations he describes are real, but all identifying characteristics have been changed, or permission has been given, in order to protect patient privacy.

4 COMMENTS

  1. Absolutely! The five different psychiatrists my son saw during his 8 months illness were all well-meaning. The only problem with them was that they didn’t listen to what I was trying to tell them. They also seemed to be ignorant of the fact that one could get psychosis from a horribly infected toe. They put him on olazapine and diagnosed him “mentally ill”. He developed NMS from it. We were told that you could not get NMS from olanzapine and they didn’t check on him in hospital during the night when he was in the grip of fever. He discharged himself from the hospital and I personally saw what the olanzapine was doing to him. He tried to get off the olazapine and could not. We tried to get help but our Gp didn’t know how to and the psychiatrists refused because they were sure he was suffering from schizophrenia. So we had to go it alone. At the end he tried to kill himself because he could not stop walking day and night and he could not sleep. It was horrendous! The thing is: I am certain that all those doctors would have been able to help if they only had listened to what we were trying to tell them. Instead of listening they treated me like the poor old deluded mother unable to accept that her son was “mentally ill”. Eventually I found Dr Breggin’s books. My son has been off medication for 3 years now but he is still shaken and scarred by what happened to him.

    • If someone were to do an in depth and very honest review of psychiatric care they would find that “lacking insight” and “grandiose” are too often synonymous with the “narcissistic wound” so many mental health professionals feel when a patient disagrees with them and challenges their authority.

      That so many of them are neurotically and judgmentally obsessed with every little aspect of a patient’s affect while they themselves wear disgust, fear, and feelings of smug superiority like a badge is just too precious.

  2. In the new system the difference between a drug and a medicine needs to be discussed and explained to the patient , before the patient consumes the chemical.
    A drug being a luxury someone doesn’t truly need to live, but can get from a doctor to ease ones suffering.
    A medicine being a necessary treatment for a physical disease (outside force) that is actively harming the human body.
    A medicine has a start and finish date ( the disease is killed), a drug does not have a finish date.

  3. Hey Mark,

    Well, as a funny aside, here is a youtube video that addresses just that. http://www.youtube.com/watch?v=Sdn3O6aaMNc

    Seriously though, I put more responsibility on the doctors than you do. They are phoning it in, not doing their best. Not sufficiently engaged to truly care. That’s not ok with me. When you have this large an impact on people’s lives, make as good a living as the doctors do, then that also bestows a lot of responsibility. A responsibility they are not living up to. This man you mentioned above had several of his years lampooned by doctors who does not care enough. Maybe this is an example of the negatives of doctors who are taught to keep a rather large “professional distance” between themselves and their patients. The doctors who prescribed and destroyed several years of this mans life doesn’t even get one sleepless night as a result of their irresponsible actions. Again, not ok.

    Sorry, this isn’t just a thing of “we are doing our best in this difficult wicked world”. That abdicates the very real responsibility that comes with the title, the education and the income.

    Anyways, hope the youtube link brings a smile to someone’s face. It is pretty funny.

    Malene