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?
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.