I’ve given the “the speech” hundreds of times. I’ve given the speech to skeptical young people, to frightened families and to many homeless men and women. I’ve assured them all that “mental illness is like diabetes and your medications are like insulin.” I delivered this speech with all good intentions and unquestioned certainty of its veracity and helpfulness.
Then I read Robert Whitakers’ Anatomy of an Epidemic. Oh sh*t! I had really bought the whole chemical imbalance narrative – hook, line and Seroquel. I now liken myself to the hapless characters in the futuristic movie Idiocracy. Whenever they are confronted with the fact that a heavily marketed sport drink isn’t really so good for plants, they counter with the tag-line; “but Brawndo has electrolytes”! I can only wish that reality was as harmless as the movie.
As I’ve looked further into the research cited by Whitaker and others, my question has become; how can we best empower vulnerable people who are seeking help and getting neuroleptics? How can we best serve as “honest brokers” without resorting to the good meds/bad meds dichotomy? How can we best fulfill our ethical obligations as “Licensed Practitioners of the Healing Arts”? What would be the best practice?
As I’ve grappled with these issues, I’ve identified a few salient points. The first one is about CHOICE. I’ve been very involved with the Recovery Model for many years and choice is considered paramount. Choice is a bedrock value of empowerment and “consumer-driven” programs. But there’s another word I have also continued to frequently hear amidst all the hopeful language of the recovery movement – non-compliant. In many recovery-oriented programs and clinics there remains a fixation, a myopic focus on persuading, reminding, nagging and cajoling people to take their meds. Choice isn’t what happens by default when we’ve exhausted our efforts to persuade someone to take their Zyprexa. Often times, “consumer-driven” crashes into the wall, when it comes to people deciding whether to take their prescribed pharmaceuticals.
It can get intense. I’ve listened at team meetings where every positive step, every hopeful sign and improvement is ascribed to a person taking their meds. Conversely, I’ve witnessed every set-back, every disappointment and crisis attributed to “non-compliance.” Non-compliance is such a telling word – it conveys such arrogance. It presumes; “we know what’s best for you and you are refusing to do it.” Non-adherence is a softer spin, but the same spirit. We shouldn’t be surprised that so many psychiatrically labeled people routinely lie to us or avoid mental health professionals altogether. Maybe we should begin to label mental health professionals as being non-compliant with their members’ choices.
Another point that gets raised is that discussing medications with a consumer is beyond a non-M.D. practitioner’s scope of practice. This group feels more comfortable referring a questioning consumer back to his/her psychiatrist. While we certainly should not advise people to start or stop their medications or adjust dosages, my sense is that this is side-stepping the issue. Certainly we can assist the person in learning about the risks and benefits of neuroleptics, ensuring that they are aware of alternatives, and supporting them in asking questions of their psychiatrist. The doctor does not always know best. As advocates, how can we effectively assist marginalized people find their voice?
So; no more speeches. More listening. Can we begin to create a safe space in our hearts and minds, and in our clinics and mental health programs for an open dialogue about what may help, what may heal and what may hurt?
*CARE*
“Recovery starts with Non-compliance,” as the badge (or button, as you USA’ers say).
And, “Choice,” where, “Choice,” means, “Do as I say,” is a hypocritial lie and what is more it is, to use Laing and Esteron’s phrase, a madness inducing, “Double bind.”
But then it gets worse because if you do not take the meds and have a drug withdrawal induced relapse you are blamed for your worsening state. Then you get told that the services are so much better these days because they are, “Recovery focussed.” Peer Supporters are all for, “Recovery”, it’s a concept developed by Service Users so it’s bound to be a good thing.
Well that must be a triple, or even quadruple bind.
Four legs good, two legs better. Oh Brave New World (that has such people – init?) Etc etc. Bah humbug
It’s always a relief to see one more professional who gets it. Thanks for the turn around and for writing about it on MIA. 🙂
Thanks for writing this. It is exactly what I was trying to get across to my son’s psychiatrist. He looked at me puzzled and asked “What exactly do you want from me?” he had prescribed the Risperidone and as far as he was concerned, his job was done. My son had been sectioned, so he had no say in any of this. The GP too thought her job was done. Neither inquired why my son had broken down in the first place. The psychiatrist was still young and inexperience but the GP was in her late fifties: she should have known better.
“What exactly do you want from me?” asks your son’s psychiatrist.
“Get a new job more suited to your abilities, such as a car mechanic or a middle manager in a job centre,” is the answer that lays at the back of my head, ready to trip off my tongue these days. And although I’ve never used that response it often seems the most apt.
That or hand then relevant articles from this website, ask them to read them, add them to your son’s notes and then write a follow up letter asking them to confirm they have done so. Having established that there are alternative points of view held by reputable professionals and backd up by sience and that the proffessional you are dealing with has read these opinions then you maybe in a better position to complain if things go wrong.
I recall talking to a psychiatrist who had been working with a seriously depressed woman for 15 years. He’d never even asked her what she was depressed about. When I asked him about it, he acted as if it was an irrelevant question. He “tried everything” in his medical repertoire, but hadn’t bothered to ask the most obvious question that your average 8 year old would have instantly known to ask: “Why are you sad?” I guess if your chemicals are imbalanced, it’s your problem, and it doesn’t matter why it happened. Very handy for the practitioner, because it doesn’t require them to think too much, but for the client, a bit of a different story.
— Steve
Any physician (including psychiatrists) is ethically and legally obligated to receive informed consent before beginning any medical intervention. This includes explaining: the risks and benefits of a proposed treatment or procedure; alternatives (regardless of their cost or the extent to which the treatment options are covered by health insurance); the risks and benefits of the alternative treatment or procedure; and the risks and benefits of not receiving or undergoing a treatment or procedure. If your physician fails to obtain informed consent, I would seriously consider finding another more qualified physician.
Ultimately physicians, nurses, social workers and family should strive to work as a team, rather than act antagonistically, and foster healing, trust, understanding and compassion among patients and the community as a whole.
Thanks for the input, Bob – I do understand the requirements of obtaining informed consent. My experience is that this usually entails more of a form to be signed than a learning process. It just doesn’t seem so cut & dried for me on how one covers the nuances of risk/benefits – as this blog would attest.
Bob1999
You know how this is supposed to work, and I know how this is supposed to work, but guess what? The psychiatrists that I see working with “patients” every day in the hospital where I work don’t seem to understand this one little bit!
I was never given any facts about the so-called “meds” that I was put on while in this very same hospital and now when I go through the units and ask the so-called “patients” about what they’re told about the so-called “meds” they tell me that they were told that they need to stay on these so-called “meds” for the rest of their lives.
Hmmmmm……when I pursue this I find that they’re not told anything about the effects nor the dangers of the toxic drugs.
I was never told about the tosic effects of these drugs when I was put on them in the private psych hospital where I was held before I was sent to the state hospital. They just wanted to make sure that I took them like I was “supposed to,” including having to open my mouth and stick out my tongue in front of them, as if I couldn’t be trusted.
I have very volatile blood pressure. One day when I got angry in that private hospital it spiked dangerously high. The nurse took my blood pressure, became very alarmed that I might stroke out, and gave me a benzo to take care of it, instead of anything for blood pressure!!!!!! Was I informed that these damned things are addictive and very difficult to get off of? Absolutely not but from then on at every “med” time there was a little benzo setting at the bottom of my little “med cup!”
So, how do you account for the fact that informed consent seldom makes its way to the so-called “patient?” You know and I know about informed consent so why don’t a large number of psychiatrists know?
So much for ethics and legality!