Winners of the American Dream

Alice Keys, MD
62
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Since I left the psychiatric prescribing trenches and came south for the winter, I’ve been staying in a beach town within driving distance of a technology metropolis. I take breaks from my writing and walk to the beach. There, I meet and talk with the winners of the American dream. They are intelligent, highly educated and financially successful. They take their beach vacations here.

One woman I meet at the beach calls her kids over from the sand so she can cover them with sunscreen. After we sit near one another for a time, we begin to talk.

She’s a busy professional who drove over with the kids for a few days off. Her father is scheduled for a procedure soon. She’s surprised when I understand the medical lingo. So I reveal that I’m a doctor.

I also tell her I’ve stopped working.

“Medical practice has turned into pills and tests. It’s not medical care any more. There’s no time allowed to talk to patients.”

I watch the calculations behind her eyes.

“That’s a long time in school,” she says. “Expensive to throw away.”

“Yes,” I say. “It is.”

She tells me she’s lucky she has a primary care doctor who doesn’t believe in tests and pills. Her doctor is a rare gem.

We trade mom stories for a while.

“What kind of doctor?” she asks.

“Psychiatrist,” I say. “Pills are the only thing left in psychiatry. So I stopped working.”

“I’m not a pill person,” she says.

“That’s good,” I say. “Our country has the highest rate of antidepressant use in the world.” I shake my head.

“Yes.” she says. “Almost everyone I know takes antidepressants. Even my sister takes antidepressants.”

It must have shown on my face.

“But she has a clinical depression” she assures me. “She needs hers. They had to try all kinds of things to find a combination that would work.”

Then she tells me that almost everyone she knows has a child on psychiatric drugs.

I tell her that there are schools in the U.S. where 40% of the kids have been diagnosed with attention deficit disorders. I tell her how much putting drugs into developing brains frightens me.

Psychostimualants. Methamphetamines. Speed. Antidepressants. Antipychotics. Benzodiazepines.

She smiles and nods.

She’s really not a pill person.

She’s skeptical.

But her son is anxious, has trouble sleeping, needs to be reassured, forgets things. He has an education therapist at school. She’s been told her son has serious problems with his brain connections.

“He has ADHD,” she confides.

They’ve scheduled a consult with a psychopharmacologist. She’s grateful to have access to specialists through her insurance.

“He just needs something to break the cycle,” she tells me.

“Do more reading before you change his brain with drugs,” I suggest. “Drugs are hard to stop. There are serious withdrawal symptoms.”

I review for her the financial conflicts of interest that make it unlikely that she will receive an unbiased medical opinion of her situation: pharmaceutical money in medical education, drug research, FDA drug approval, NAMI and pervasive drug advertising.

Her eyes look increasingly worried as I go through my litany. I sound like a conspiracy theorist. And I’m just some random person she met at the beach.

She will come out of her psychiatry consultation with drugs for her son. She has health insurance. She is among the winners of the American dream.

 

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Thanks for reading, thinking and writing.

Alice Keys MD

62 COMMENTS

  1. Gosh, it’s time to read Brave New World again.

    I’ve had that, “Clinical depression,” talk before. The one I remember was with someone who said her breakdown was, “Endogenous,” a term that has gone out of favour. It meant her depression and mania were not due to her situation. She then went onto tell me that she had an unhappy childhood, her husband was unfaithful and had given her the cold shoulder in bed. She was working full time, bringing up two children and involved in political campaigning when she first had a breadown. She hadn’t been been serioulsy depressed or manic for a couple of decades. But it was all chemical and she needed the lithium, the anti-depresent, and the sleeping pills and probably would for the rest of her life.

    Well that’s what she said.

    Then her kidneys started to pack up.

  2. Thanks again for another insightful article. When I was in Social Work grad school I worked as a residential assistant to a residential treatment center. The center used to be for unwed mothers and had many places across the States. Back then in the late 70’s and early 80’s is was for “troubled” teenage females. Read basically homeless due to abusive issues. There was no medication protocol. Treatment as in individual, group, and family therapy along with therapeutic milieu were used to fairly good effect. The worst behavioral activity was running away which was always quickly rectified.
    When I spent my time in the psych or prison units last year. The television was encased in a large metal box and locked.
    According to my hospital records there was one group held by OT’s on self esteem. I was considered a bad patient because I made the statement that OT’s should not be running groups on self esteem and that that was the provision of Master level Social Workers. I actually ran a group for inpatient psych patients back in the better days. They consider my claim to be a Social Worker as delusional and grandiose.I feel a group on self esteem in a prison setting psych unit to be cruel and unusual punishment.I distinctly remember staff members getting into a fight on the night shift and I located a non American very very rich female psychiatrist who was trained as a surgeon in her native country to ask for help. She knew my husband ( a burnt out Mental Health worker who is putting in time for retirement) through work and refused to do anything to help or diffuse the situation. I brought watercolors brushes, and paper and was the defacto true OT during my time there. The OT rooms were continually locked and filled with wonderful stuff that was never used.
    I blame my brainwashing for my need for hospitalization. I truly believe the psychotropic meds made me worse. I never witnessed any violence just bored to death patients with nothing to do but wait for discharge and freedom.
    We really need to have journalist go undercover and see what is happening. I think that will be the only way to stop Big Pharma.

    • I had an experience similar to yours when I was in the state hospital. I was considered delusional and a liar because I’d told the staff during my intake that I was a former chaplain who’d been trained in psych hospitals so I knew something about what went on in the units! My friend, who just happened to end up being the social worker who was designated to take my social history (we’d not seen one another in almost fifteen years) heard the nurses calling me a liar while she was waiting for my session with the psychiatrist to end. When she realized what they were talking about she broke into their conversation and set things straight. They ran into the conference room to get away from her!

      I agree, we need people to do some undercover work.

  3. I’ve noticed this myself. Most people who say that they are skeptical of drugs or are not a “drug person” are quick to side with the drugs, believing somehow that their case is different. It was widespread after the 60 minutes special featuring Irvin Kirsch. Comments across the internet were filled with lines like “Of course anti-depressants don’t work for people who have real clinical depression, but for those who do they are a life saver!”

    And of course, whenever and wherever people talk about drugging kids, people who are not totally for or against it are like “Well they are definitely over-prescribed, and a lot of them don’t really have [insert diagnosis] (I like to say: How do you know? You’re not a doctor) but some kids really need those meds, blah blah blah (Again, how do you know?)”

    It seems most people in the U.S. are of the opinion that psych drugs are bad, except for when they are not, which is whenever they feel assured that some case is different. It’s irrational thinking considering the fact that the legitimacy of their use hasn’t even been proven for a single disorder, not even schizophrenia. How can there be even a single case where they are absolutely necessary, when they do not in fact fix brain malfunctions and no human being — especially a child — has ever dropped dead in the history of the human species because they didn’t have a psychiatric drug in their blood stream.

  4. The idea of changing the system has been done in the past. The UK was active in changing and ultimately her visit there led Dorthea Dix to investigate and challenge the abusive American Mental Health system.I really think we need Michael Moore of some one of his ilk to do a documentary. I think there were some investigative journalists in the 1960’s who did go in undercover. Writing as you do is enough for you!
    These days documenting the truth would be much more difficult than in earlier decades.
    Saul Alinsky who wrote “Rules for Radicals” was a wonderful community organizer who was able to pinpoint the weak spots of the opposition.
    I think there needs to be a two prong approach one delineating the
    current poly pharmacy and one bringing to light the whittling down of psych units to mere holding pens.
    The problem with the “Bring Change to Mind” campaign has been highlighted here on MIA.What they could do if they were aware!!!
    My only thoughts are having volunteers come and monitor the hospitals akin to the UN monitors for elections in despot countries.
    There is a very good but scary book called “Feed”. In my less optimistic moments I fear the book( written as a literary satire for young adults) will become reality. I hope thought a surge is coming that will change the course for everyone involved in Mental Health.

    • I think that the alternative, as always, is to think about what is going on and to change what can be changed. In schools the issues that drive difficult and disruptive behaviour are many. But the very fact that the number of children on these drugs keeps growing points to ADHD/ADD being a not very valid diagnosis.

      In the UK there was a programme in London where the good teachers from the good schools had time to go to the not very good shcools to help the not so good teacher bring up thier standards. That might well reduce the number of children put forward for diagnosis as I believe it is often the young and inexperienced teachers who have poorly developed class room control techniques that are likely to put children who they find disruptive forward for assessment. The more experienced teachers often don’t have a problem with the child, so passing on their skills would redue the impulse to medicalise the child

  5. Hello Alice. I have an opinion I’d like to share about this post. Why do you think the woman at the beach is the winner of the American Dream any more than you are? I mean, there you are, walking to the beach, writing in between, renting only until you can figure out what to do next, as in buying a home? It sounds like you each have the American Dream, just two different versions. Indeed, you were both at the same beach.

    I do believe your writing is worth something, but what about offering your medical expertise to people who can’t afford holistic alternative care? I understand you like writing, and perhaps that is your calling, but its too bad that a person with your education and experience can’t offer alternative help to people who need mental healthcare. And, you could go undercover, as a writer.

    Personally, I don’t see your having quit being a psychiatrist as a justice to our mental healthcare system or the people in it. Obviously, you were smart enough to get through medical school, so you could learn acupuncture or another type of holistic care.

    I hope you are writing in other places than this blog. I like this blog, but I really don’t think many psychiatrists who are still writing prescriptions every ten minutes are reading it, which is too bad. I wish they were!

  6. That mother on the beach could have been my mother, or one of my sisters. In fact, she could have been my psychotherapist, or my lawyer, accountant or child’s principal. I have heard the same from the masses. There are far too many people that claim they are not pill people, but willingly accept the “professional’s” opinion. Finding a good psychiatrist is more difficult than finding a good mechanic. People look for professional advice and rely on the system to provide it. I understand why you would not want to be a psychiatrist anymore. You are intelligent enough to understand what is wrong with the system, and now you are trying to find out how to fix it.

    Your simple observations are great… we all relate to that woman on the beach. How does change occur… real change. I think of the AIDS epidemic and how it consumed us for years. We did not cure AIDS or eliminate HIV infections, but we did educate. The power of the media and celebrities helped, public service ads… How can we create such an outcry? That is the real question. There seem to be lots of movements… you yourself said you were starting to sound like a conspiracy theorist. It is not a theory… there is proof. Whitaker’s book… countless ex pharmaceutical reps… but how do we get the message to the masses? That’s what I’m trying to figure out.

  7. Hi Alice, just to say I loved your post. A tad dystopian, but true enough.

    As a former psychiatrist, your in a unique position to tell it how it is, and possibly be believed. Whereas as a former patient, if I ever speak my mind on psychiatry, it merely confirms an obvious need for meds. So keep up the writing…