I have some trepidation as a social worker venturing into the world of ecology and biodiversity but during my recent visit to Hawaii, I began to realize there are some parallels in that world and ours. Bear with me for some quick background.
Hawaii is a long ways from every other land mass in the world–the most isolated place with mountains nearly 13,000 feet in elevation on the Big Island and still growing its coastline there. Human settlement didn’t take place until probably 300 AD or so. What the early Polynesians found was a unique natural environment that had plants and other living things that had developed in isolation for probably millions of years. Today, 90% of the indigenous plants are still around, although they constitute now only 10% of the total plant species around the islands.
There seems to be some degree of reasonable accommodation (if I can use a term that has some possibly crossover meaning with the field of social work — I’m stretching here, right?) between the original flora and fauna on the islands and those that came later. But there are clearly some relative newcomers that can be considered “invasive species.” Another relatively isolated area, the Yukon, has an environmental organization, the Yukon Invasive Species Council, that defines the term this way:
An invasive species is defined as an organism (plant, animal, fungus, or bacterium) that is not native and has negative effects on our economy, our environment, or our health. Not all introduced species are invasive.
So here’s the possible parallel in our fields — could psychiatric medications be considered an invasive species in the world of mental health?
Most of us would probably agree that there have been many traditional ways that people who experience the world differently have been understood — or not — or simply dealt with. Some of these “indigenous” approaches have been more positive than others. We can recognize the most inhumane of these as various forms of isolation, demonization, discrimination, torture, institutionalization and worse. More concrete examples include lobotomies, electroshock “treatments” and psychosurgery.
Other understandings from the past now seem obviously more humane and relevant–the consideration that individuals who hear things or see things or imagine things that others don’t actually have meaning for their culture — visions and insights that must be respected and given some meaningful application. More modern approaches viewed people with unusual thought or verbal expression as articulating personal concerns that for whatever reason could not be translated into more ordinary language. Family approaches have considered the ways in which what many would call mental illnesses are actually methods of calling attention to dynamics in the family that are not safely expressed otherwise.
Various cultures including many in our own experiences have found that yoga, meditation, exercise, breathing exercises, and psychotherapy are methods for working through or around what might be considered mental health or psychiatric problems. The world of western mental health programs have developed more technical interventions like psychodrama, psychiatric rehabilitation, “case management,” supported employment and education, peer supports, and housing supports. And we have been learning more and more about the importance of trauma-informed care.
That brings us to psychiatric medications. In the early to mid 50s, we should remember that they seemed to offer dramatic hopes for improvements over the more obviously brain damaging practices in western mental health institutions. Some people clearly improved and could move back into some form of community life after taking them. Others responded well but may have been affected mostly by the belief that they could get better by those around them who believed in the medications–rather than the medications themselves.
Gradually, over the past half century, psychiatric medications have been increasingly seen in western cultures as a restoration of an alleged chemical imbalance. This has become a culturally embedded belief largely prompted by a highly sophisticated marketing and educational strategy employed deliberately by the pharmaceutical corporate industry. The idea was then swallowed hook, line, and sinker by professionals in practice and training and even “research”–largely funded by the industry. The term “15 minute med check” illustrates the common practice that is ubiquitous not only in hospitals and clinics but increasingly in jails, prisons, schools, juvenile corrections, nursing homes and drop-in programs.
It’s at this point that one can make the argument that psychiatric medications have become an invasive species–taking precedence over and reducing resources for any and all of the other traditional and nontraditional approaches. I can provide many examples but one dramatic story of the drain on resources and the centrality of psychiatric drugs for children comes to mind from my own professional and administrative experience. Sen Grassley of Iowa provided us a few years ago with a picture of the highest billers of psychiatric medications and there were 2 physicians in the community I was responsible for that knocked me off my feet. One had prescribed $457,000 of Abilify to children and youth in just ONE YEAR. The other physician wasn’t far behind. The program in which they worked thought nothing was amiss. I had to wonder what other supports and services to the families and schools could have been provided with the extra nearly $1,000,000 involved.
I’ve been reminded that not all invasive species have completely deleterious effects so I’m not making the argument that there is no one who can benefit from some level of psychiatric medications. I have dear friends in the advocacy world who do make use of minimal to modest doses of medication. That is their choice and is often taken with full knowledge of the potential ill effects.
But isn’t it time we recognize the parallel between ecosystems, flora and fauna and our own world?
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.