“A More Comprehensive Approach to Ethical & Effective Prescribing”

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Psychiatrist Mark Ragins writes in Community Psychiatrist about a new approach to his practice, “Prodded by Robert Whitaker’s books, I feel the need to build a more comprehensive approach to ethical and effective prescribing than I was taught or modeled or even than is expected of me. Here are four more foundations I’m building: 1) Individualized prescribing, 2) Recovery based prescribing, 3) Trauma informed prescribing, and 4) Toxicity informed prescribing.”

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9 COMMENTS

    • Great point David.

      I am really getting tired of these psychiatrists who sound so reform minded espousing stuff like this without evidence. It is like he wants to have it both ways which really galls me.

      By the way, I am not against them being prescribed as long as the person is given fully informed choice. But I was concerned in reading the article that Mathew posted a link to that that wasn’t occurring.

      • I don’t post the news stories.

        I understand that it may feel “galling” to interact with people who are “on the fence,” and I’d also suggest that these are the very people who are among closest of any psychiatrists to fulling grokking the issues that we talk about here. We could choose to be pessimistic and speculate that he may want it both ways, or we could choose to respond with enthusiasm that more people want ethical reform at all. After all, it can be a truly difficult process to shed beliefs developed over years of training in a faith-based system like psychiatry, and this man appears to be going much further than most.

        • Matthew, you make some good points. I guess I was suspicious when Dr. Ragin was claiming that untreated psychosis causes the same type of brain damage as med does without proof.

          I also realize that not every psychiatrist is going to be 100% against meds. But he seemed to be doing more fence straddling than I was comfortable with. Only time will tell as to who is right about his positions.

          • The other reality is that even if the same brain damage was present, fact remains that at least the rest of the body will still be alive and functioning if they are not on the drugs. The medications/drugs cause damage to every body system, very convient to focus only on one and not the others.

            It also does not suprise me that he is only making some changes. Like Mathew I think it is simply too huge a leap to move to the direction of just how much damage these drugs have caused to people and the damage that they themselves have done over the years they have been practising and all of them would have had some involvement with involuntary treatment as well.

            I also find the concept of informed consent ironical. I do not believe that anyone can give informed consent to take these drugs, as doing so would involve knowing the real side effects, that no disease actually exists, and that their is no evidence that they would do anything for you and would infact only harm and likely kill you. No one would truly give informed consent for such treatment. Rates of forced treatment are decreasing while the rates of prescribing are increasing for the simple fact that people believe they have a brain disease and that these drugs, labelled as medications can fix it. Most people don’t need to be forced. And while I am all for getting rid of forced treatment, fact remains it would do nothing to change the mental health system or the treatments dished out to most people, and nor would it change societies strange views on such things.

  1. I find it encouraging that these discussions are happening at a more mainstream level. It does not surprise me that psychiatrists have to “save face” by hanging onto some threads of their old thinking. It is, of course, scientifically wrong, but we should not delude ourselves into thinking this is a scientific process. This is sociology and culture change, and it is slow and incremental. Nobody every just says, “You know, our entire approach was entirely wrong and we’re scrapping it.”

    I’m glad the guy is talking about humility, about the evidence that brains are harmed by the drugs, and about the now established fact that many folks do well with minimal or no drug intervention. I also like that he calls out his own training and lets us know that a lot of it was just plain wrong. That takes some courage, and we need folks like this to help turn the discussion in a more sane direction. Not that I think this moderates the need to take psychiatry out as a medical specialty, but an acknowledgement of at least a large subset of the actual facts is refreshing to me.

    —- Steve

  2. Thanks for posting this. Dr. Ragins is a thoughtful psychiatrist who does excellent work. Check out “The Village” which seems to be a model for a recovery oriented program in Lost Angeles.

    http://mhavillage.squarespace.com/

    It was notable to me that the issue of the American Association of Community Psychiatrists gave so much time to this topic (without any rebuttal). The Editor’s note included an honest statement about Whitaker’s work and why we need to pay careful attention to what he has written.
    Sandy