How Do Clients Solicit Medication Changes With Psychiatrists?

Researchers examine psychiatrist-client interactions and find that clients are often left with few opportunities to make explicit requests to change their medication regimen.

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A new paper, published in Sociology of Health and Illness, describes the findings of a study that examined conversations between psychiatrists and clients to understand better how clients initiate attempts in session to change their medication regimens. The results of this conversation analysis, conducted by Dr. Galina Bolden and a team of researchers, revealed that clients have few opportunities to explicitly voice preferred changes, a structure that undermines a collaborative decision-making approach to treatment.

“Previous research suggests that clients hesitate to assert themselves in clinical encounters out of deference to clinician authority,” the authors write. “It is not enough, therefore, to exhort psychiatrists to listen to their clients’ preferences when they express them; rather, it may be necessary to train them to create explicit openings for their clients to articulate their experiences, such as, for example, explicitly raising medications as a discussion topic.”

The recent emphasis on client-centered care has focused on interventions that allow clients to direct treatment decisions. Traditional understandings of decisions around psychiatric medication management have been oriented around the psychiatrist as the professional, who holds the expertise to make decisions regarding a client’s care. However, the movement toward Shared Decision Making (SDM) focuses on treatment decisions made in collaboration across practitioners and clients.

Previous studies have observed conversations that occur between psychiatrists and clients. These findings provide insight into how psychiatrists go about making treatment decisions. First, it has been noted that the structure of the conversation is set up such that the psychiatrist is positioned as making the treatment recommendations. In these discussions, they do not tend to invite medication requests from clients. This is noteworthy because, Bolden and colleagues note, “there is no structurally provided place for patients to make such requests.”

In addition to this, the analyses of conversations demonstrates that treatment decisions, particularly those around medication, are structured around the idea that it is the psychiatrist who holds expertise on the subject, “which means that if patients are to solicit a medication, they are normatively expected to design their inquiry so as to respect the boundaries of medical authority,” write Bolden and co-authors.

For this same reason, although patients might have information about their experience with medication, their opinions may not be viewed as legitimate by providers. It is unsurprising that in this context research has found it is rare for patients to request a treatment explicitly. Some research does indicate that rather than explicitly seeking treatment or treatment changes, patients engage in a variety of implicit strategies including:

  • “Producing a candidate diagnosis (e.g., ear infection) that implies a certain treatment;
  • Stating their preferences, making inquiries, mentioning prior experiences with particular treatments;
  • Emphasizing the severity of their symptoms;
  • Citing precedents, third parties, or praising other providers who prescribed the desired treatment.”

By deploying these strategies, patients balance respecting the authority and expertise of the psychiatrist with their personal advocacy and desire to express treatment changes or preferences. A significant downside to understanding the structure of these conversations is that the existing research of in-session treatment discussions has focused on examining how psychiatrists navigate them. Bolden and colleagues write:

“By focusing on the communicative work psychiatrists do to promote their treatment decisions, this research has provided an important but limited insight into shared decision-making processes.”

Therefore, Bolden and researchers sought to investigate conversations in which clients solicited changes in their medication regimens. Examples of instances in which clients would be soliciting changes include requests to lower dosages, eliminate medication, and prescribe a new drug.

“The present study thus advances our understanding of patient advocacy in mental health settings, adding to a small but growing body of conversation analytic literature on psychiatric interactions.”

Bolden and colleagues analyzed “medication check” appointments at an assertive community treatment center. These appointments featured psychiatrist-client negotiations of changes in medication type and dose that occur in an ongoing fashion alongside other services offered including “training in everyday life tasks, supportive psychotherapy, and assistance with gaining disability benefits and housing.”

Their findings resembled earlier studies and offered further evidence that patients implicitly communicate medication preferences in psychiatry sessions. However, there were instances in which patients made explicit requests. Even still, the tendency to design requests to defer to the psychiatrist’s authority and expertise persisted and these requests were often initiated only after the psychiatrist had brought up the issue of medication.

Some patients openly demanded a medication change (e.g., “I want my meds lowered”). The researchers’ analysis details how these different types of requests correspond to varying levels of pressure that get placed on the psychiatrist.

Bolden and colleagues describe this point:

“First, when clients report problems they experience, the psychiatrist is put in a position to propose a treatment to address the problem. Second, when clients attribute a problem to a particular medication, in addition to offering a solution, the psychiatrist has to either accept or reject the client’s attribution. Finally, when the client requests or demands a medication change, the psychiatrist’s response is normatively constrained to either granting or rejecting the client’s request.”

A deeper dive into the results of this analysis demonstrates that there are different “phases” that occur throughout a typical “medicine check” appoint. The first phase involves the psychiatrist asking questions to assess the patient’s functioning. This data gathering stage is not an assessment of whether or not the patient has a diagnosis, the authors explain. They write, “The clients in this dataset have had a psychiatric diagnosis for a long time, so the issue is not whether they have a particular psychiatric condition but how well the condition is being managed by the current medications.”

Ultimately, this initial phase is to “evaluate how the current medications are working.” This is followed by an assessment of the client’s clinical state and then, a discussion of the treatment plan, including possible changes that could take place. Interestingly, the researchers found that clients initiate medication-related discussions during “activity boundaries”—in other words, at the transition points between these conversation phases.

In addition to this, client-initiated discussions manifested in a variety of ways:

Reporting a physical problem without attribution to medications. This strategy involves a client discussing a physical issue that they are experiencing that can be understood as a side effect of a drug. However, they do not mention the medication specifically.

Reporting a medication problem. In this strategy, clients discuss a particular physical problem and attribute the problem to current medication. This exerts a higher pressure on the psychiatrist than the first strategy, explain Bolden and colleagues. They write:

“When clients attribute a problem they experience to a particular medication, they constrain a range of appropriate responses, and thereby exert more pressure on the psychiatrist. Now rather than simply offering a solution to a problem, the psychiatrist is expected to validate (or reject) the client’s attribution and to grant (or reject) the implicit request for a medication change.”

Explicitly requesting a medication adjustment. In this approach, clients are openly asking for a medication change. However, this request is often crafted through what the researchers referred to as an “’I was wondering’ format.” They describe this to serve the function of conveying the “client’s low entitlement to making the request and a high contingency of the requested outcome. This format underscores the delicacy of the action and displays an orientation to respecting the psychiatrist’s professional authority on the matter.”

Demanding a medication adjustment. Through this approach, clients overtly express a preference or desire for something to be done regarding a medication change.

Bolden and colleagues discuss these findings within their context. For example, they note that the more indirect ways of approaching a medication change, such as reporting a problem, are commonly used and have the “advantage of preserving the boundaries of medical authority and expertise.” This form of initiation also fits more seamlessly into the structure of the session conversation in that it fits as a response to a “How are you doing?” question.

On the other hand, direct requests for medication changes put more pressure on the psychiatrist to respond by either granting the request or denying it. Clients tend to convey these requests in a way that presents low entitlement to the request alongside “high contingencies in it getting granted.” Direct requests are more likely to occur if an indirect request proved unsuccessful or if the psychiatrist has verbalized potential issues with the medication.

As they summarize their findings, the authors write:

“Initiating a medication discussion is an interactionally delicate task for at least two reasons: first, clients need to find a way to raise the issue without there being a systematic opportunity to do so within the organization of a routine appointment and, second, they have to articulate their medication preferences in ways that are sensitive to the fact that medical providers have the institutional authority to make (and in this psychiatric context, enforce) treatment decisions.”

They continue, “These difficulties are further exacerbated for patients suffering from a severe mental illness since they may be seen as not having sufficient insight into their illness and because they may resist taking psychotropic medications, many of which have uncomfortable side effects.”

Given this analysis, Bolden and researchers stress the importance of training psychiatrists to create conversation structures that invite explicit opportunities for patients to voice their concerns, experiences, and treatment preferences.

 

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Bolden, G. B., Angell, B., & Hepburn, A. (2019). How clients solicit medication changes in psychiatry. Sociology of health & illness. doi: 10.1111/1467-9566.12843 (Link)

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19 COMMENTS

  1. The fish, the client wants to stay on the hook of drug addiction. Right. Not. There are no brain chemical imbalances. The legal drugs are just drugs, not medicine.

    The psychiatrist can switch up the drugs, for the patient. If the patient goes nuts from the change, it is a win for psychiatry (Patient back in psychiatry’s hospital-jail or worse). If the patient adjusts to the new drugs (with an illusion of choice or freewill) it is a win for psychiatry as they kept their “patient”.

    Remember the hero needs to be a hero by issuing helpful medications to a sick patient.
    You are sick aren’t you?
    .

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  4. It’s interesting that the study found that people mostly aren’t coming out and specifically requesting their psychiatrist to change their drug regime, much less asking them to prescribe a drug by name. This suggests that all the money and effort pharmaceutical companies are pouring into consumer-targeted TV advertising (“ask your doctor about Abilify!”) might not be working as planned….

    Also fascinating is that “patients” feel they must be deferential when talking to psychiatrists. Despite that they’re the paying customer, as it were. Clearly they understand a need to be savvy in a situation with a large power differential.

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  5. Following up on Miranda’s comment, I find it interesting that the fact that the clients are feeling too intimidated to speak up is not considered to be the central problem in this interaction. If you want “shared decision making”, you need shared power, and the current model goes against that. “Clinical authority” is simply the asserted right of the psychiatrist to dominate the decision-making process. In other words, most psychiatrists don’t BELIEVE in shared decision making. This should be the primary focus if someone really wants to change that dynamic. I actually make it very clear to any doctor I have to see that I am, in fact, the one making decisions here, and that their advice is advice which I may accept or reject, and if they don’t like this attitude, they should let me know now so I can find another doctor. But most people are very uncomfortable taking that assertive a position.

    This also belies the “blame the patient” approach to explaining away the steady increase in prescribing by doctors in every area of medicine. These things are not happening because the clients saw Drug X on TV and are demanding it. In most cases, it is the doctor who is deciding what the patient is supposed to take, and it’s clear from this discussion that most patients don’t have the skills or the wherewithal to challenge the doctor’s opinion on any recommendation.

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    • I actually make it very clear to any doctor I have to see that I am, in fact, the one making decisions here, and that their advice is advice which I may accept or reject, and if they don’t like this attitude, they should let me know now so I can find another doctor.

      I do the same thing, Steve. I make it very clear that although they have expertise in medicine, I am the only expert when it comes to what is best for me. The doctor is my consultant; their job is to give me ALL the pertinent info, period. I decide by their reaction whether they get to be my doctor or not. I don’t hesitate to fire the ones that can’t color within my lines.

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      • Hi LevenderSage, Most doctor’s do not have expertise in medicine, because if they did, they wouldn’t be prescribing them and there would be no medical field, other than for life saving measures. The medical/mental health industry is a money making scheme, where making us believe we are ill is profitable. Most doctor’s push dangerous medications because that is what they are trained to do, given the medical model and the drug based paradigm we live under. Doctor’s get kick backs from prescribing the latest med not even knowing (or knowing) the ramifications of the latest popular medication that they are handing out like candy. I firmly believe that most science surrounding poisonous medication is cooked up research to push a hypothesis that medications are safe when they are definitely not.
        JUST SAY NO to pharmaceutical drugs. I do my very best to stay clear of the medical and mental health establishments.

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        • Hi Starr.
          I know. I have never trusted doctors on the whole. Trust is earned, never handed out like candy by me. I have never been the type of gal that sought routine or preventive care. Nope, I’m the gal that fired her OB at 31 weeks’ pregnant because he was pushing for a completely unnecessary cesarean, found a midwife and birthed the baby at home. Then about a year and a half ago, I started having problems with my vision. I had been having headaches which presented exactly like migraine for almost 3 years at that point, but I dealt with them using cbd, aspirin, and napping a couple hours. Turns out it wasn’t migraines; it was intense spikes of pressure in that eye. Now I’m functionally blind in that eye, and I return to the ophthalmologists every 3 months to keep tabs on the pressure, optic nerve health, and visual field in the remaining eye. My perspective on the medical field has not changed. I go to these appointments and put up with “medical science” because they are my only means of accessing important info about the way my body is working (or failing to), but it is not without pause.
          I went to a GP appointment last week because I’ve been having troubling sensations in my head (very hard to describe) and also high BP. I don’t think the two are related, but I am unsure. What I need to do is consult a medical intuitive who can tell me what direction to point the doctor in, so I can tell them what tests to run, what to rule out. Now that I’ve put this intention out there, may the right person be drawn to me to help with this.
          Anyway, I liked the GP I saw (actually an NP) but I will know more about how much to trust her when I ask next time to see the notes she wrote about our first interaction. Her response to this, as well as the notes themselves, will tell me a lot.

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  6. How do I feel about advocating for my loved one’s right to taper off her medications with her psychiatrist? Terrified. If a loved one has been involuntarily committed, forcibly drugged, and institutionalized for nearly a decade, the psychiatrist has all the power in that situation. He/She has the power to fire your loved one. That means your loved one will have her drug supply disrupted. Since her brain is highly habituated to the poisonous cocktail she has been taking for years, disruption of your loved one’s drug supply puts him/her at high risk of a rebound psychosis which is commonly called ‘relapse’ by clinicians.

    Your loved one will end up in a hospital where every progress he/she has made deprogramming the internalized messages of hopelessness fed to people in locked wards, will be set back yet again. Any progress he/she has made tapering down in cooperation with his/her shrink, will be reversed. At the hospital, they will once again be drugged to the gills.

    You must perform and instruct your loved one to perform and get through the med check interview by being as cogent as possible, cheerful, on point, etc.

    You and your loved one must find, at your own expense the one in a thousand psychiatrist who is open to the possibility that your loved one’s best shot at long term recovery may be attainable only by getting off meds. This search can take years. This person must be in private practice and willing to treat someone who they may consider a ‘severe’ case. Most shrinks in private practice want to treat only the worried well who have good insurance.

    As a parent, I have witnessed first-hand the way that my loved has slowly deteriorated while being ‘med compliant’ but neither she nor I can open the conversation in these 20 minute med checks by ‘educating’ the psychiatrist about the psychiatric abuse and horrors that my daughter has experienced in a host of locked back wards. In twenty minutes, I can’t begin to describe to the shrink in front of us why I or my daughter have zero trust in his judgement. There is never enough time in a med check to recount the horrors that are routinely meted out with inpunity by members of his profession.

    And side effects, you can’t dwell on those either. You cannot open the conversation by describing in detail the times you have held the vomit bowl for your loved one because of the clozoril, the number of times you changed the sheets because of the incontinence caused by the lithium, the neuropathic pain and the labored breathing and feeling of being choked by respiratory akasthisia. You cannot describe the cognitive damage, the memory issues, the inability to read, write, comprehend speech, the lack of focus, desire, or motivation and the chronic fatigue. They will just say you are crazy. The whole family is crazy. They are ‘anti-med.’

    You cannot dwell on the side effects because to that psychiatrist, they only care about one thing, that you are not ‘floridly psychotic’ and you are not suicidal. You also don’t have dystonia or tardive dyskinisia yet! Wow, you are med compliant and you are living at home or in the community! You must be stable, therefore you are doing great! Stability is the holy grail of psychiatrists who treat the ‘SMI’ even though underlying that ‘stability’ is the reality that people labeled with ‘SMI’ who are polydrugged are only ghosts of their former selves.

    Most parents of children who have been labeled ‘SMI’ know that their child is slowly being destroyed by the drugs but they are in denial, a state of mind reinforced by organizations like NAMI which programs people to believe that their children’s ‘mental illness’ is a chronic brain disease caused by faulty genes and a neurochemical imbalance and that the only way to manage ‘disease’ is by taking debilitating, poisonous drugs for life.

    There is absolutely no talking to these shrinks as long as they are unwilling to support their clients in undoing the damage their colleagues have done. While there is a noticeable shift taking place, and the false chemical imbalance narrative is starting to fall apart, we with loved ones in the trenches who are still heavily drugged and holding onto life by their fingernails have to approach each and every day as if they are climbing Mount Everest. My daughter wakes up each day to climb Mount Everest, then goes to bed, only to wake up and have to start climbing Mt. Everest all over again.

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    • By the way, I should mention what a wonderful person my daughter is! She doesn’t give up and just the fact that she gets up every day and tries to live life on her own terms, despite the years of psychiatric abuse she has endured is a tribute to her wonderful spirit and grit. She is my teacher everyday and I just hope that someday, her tenacity and optimism will be rewarded with an opportunity to enjoy regular, genuine conversations with a psychiatrist, one who is open minded, compassionate, not someone with an eye on the clock and a pipeline of patients outside the door, someone who will treat her like a human being with strengths and abilities and take professional risks to stand in solidarity with her desire to live a med free existence

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      • Congratulations Madmom. Your daughter is blessed to have you helping her.

        Was in the System for 25 years. Mom almost took me to Canada to see Dr. Abrams but couldn’t. She and I kept telling the doctors I hadn’t been so out of it till the Anafranil kept me awake 3 weeks. No one listened. Till they told us it proved I was crazy by “unmasking” some brain disease that couldn’t show on MRIs.

        Finally off drugs for 18 months. Mom is happy. She gave up years ago. I did till I read RW and others.

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  7. You meet deception with deception. The drugs make you feel horrible. If you complain about “side effects”, the doctor always has another drug in his drawer. Ultimately one ends up saying “yes” to the prescription, and then not taking the drug. Keep up the pretense, for the sake of doctor, family, and school or business associates, and “everybody is happy”. Spill your beans, and everybody will be wanting you to submit. Hold your tongue, and if you’re fortunate enough to evade major injury, you will feel a lot better, live a lot longer, and triumph over stupid compliant self-destructiveness in the end.

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    • Absolutely true, Frank. You’re given a drug, complain about being made ungodly sick, so the psychiatrist wants to double the amount of the drug that made you sick. You walk away from that insane psychiatrist. He documents this as a “Foul up!” but tells no one, despite having HIPPA forms signed stating he is supposed to share his mistakes with your other doctors.

      But you are forced to go to another psychiatrist by your “holistic Christian talk therapist.” That psychiatrist gives you different drugs, which make you even sicker. But when you tell your “mental health” workers you just got “voices” in you head from the drugs, they deny this is possible, and secretly think this is wonderful (according to medical records). And the psychiatrist increases the amount of the drugs and gives you new drugs. When those drugs only make you worse, you’re switched to even more drugs, multiple antipsychotics at above recommended levels. At which point a family member finally complains about the grotesque “over medication,” resulting in a slight reduction.

      So how does a client, who the psychiatrist refuses to listen to, convince the idiot psychiatrist to wean you off the drugs? Stop telling him about how sick his drugs are making you, and switch to telling him you’re doing much better. Tell him that you’re pleased to be back to functioning on a “high level” with your “peers.” Tell him you’re being very productive in your work. Show him your work, which he concludes is “insightful,” since he thinks you’re painting his “disease,” rather than painting his malpractice. Although, your work is “insightful” from the stand point you knew the banking system should be represented as an empty cornucopia, and America was upside down and backwards, way back in 2005. Something most are only awakening to now.

      Inform your psychiatrist about your new volunteer activities, like the fact you are co-chairing a 250+ member strong organization (which will get you a “not believed by doctor” comment in you medical records, despite it being true). Ignore the doctors’ ungodly depersonalizing, ‘I believe this person is a disease, not a person’ attitude. As well as most of their bad advise, like “quit all your activities and concentrate on the meds,” and “stop exercising.” Keep insisting to find the etiology of your illness with your therapist, who will eventually tell you, “you no longer need to see me,” and your only problem is a “chemical imbalance,” because she doesn’t want to honestly confess to the etiology of your illness.

      Just continue to tell the idiot psychiatrist how much better you’re doing, but that you’re still sleeping too much and exercising is a challenge. Keep requesting he reduce the “meds” – if he thinks it’s okay. Always allow him to believe he’s in charge! Have scheduling difficulties for frequent appointments, resulting in appointments at greater and greater intervals, like six months apart, so you’re weaned slowly off the neurotoxins. And finally, you’re down to only one drug.

      At which point you’re feeling much better. And can confront your PCP about her overseeing all this mis-medication, and the fact it was one of her drugs that resulted in you seeing the psychiatrist in the first place. Which results in the nurses and other doctors in that practice getting paranoid about a potential malpractice suit. So they hand over your families’ medical records, and tell you to find a new family physician. Prior to kicking that doctor and her husband, who was the “attending physician” at a “bad fix” on a broken bone of yours, which you find out from other medical records you go pick up, out of that practice.

      Then you can read the psychiatrist’s correspondence in your medical records. And you find you now have in your possession the medical proof that the psychiatrist never listened to a word you said. And there’s tons of incorrect information about you in his medical records.

      So you politely confront your psychiatrist with all his misinformation about you in his medical records, but in a diplomatic and slightly deceptive manner, since remember, he always has to be made to believe he is in charge. You tell him you’re writing a book about a highly delusional psychiatrist who covers up medical evidence of child abuse and easily recognized iatrogenesis …. Resulting in the psychiatrist writing in his medical records that you’re writing a “credible fictional story.”

      But this will result in him quickly becoming a “dangerous paranoid schizophrenic,” who thinks drugging up your child is how to help a child, who had been abused four years prior. You politely decline, since your child is doing better already, (and you’re not about to allow your child be poisoned by a child psychiatrist, don’t mention that to him, however.) Then he demands you come back very quickly with your husband. Again, have scheduling difficulties so “very quickly” can’t be too quickly. You need time to mentally digest all the medical betrayal.

      Confront the pastor who recommended the “Christian talk therapist” who initially misdiagnosed the adverse effects of your PCP’s drugs with the fact you’ve been handed over medical evidence of the abuse of your child. If he doesn’t go with you to report this child abuse to the police, as is legally required, then leave that church knowing that pastor was likely involved in the abuse of your child.

      This will result in the pastor telling his child rapist buddies about the medical evidence of the abuse being handed over. Which does result in the school, that had a child rapist on their school board, and where some of the abuse likely occurred, closing it’s doors forever, out of fear of a lawsuit. But that’s good, because there were “rumors of odd sexual behavior on the part of many boys from that school” swirling around at that point. But don’t bother going to the police or CPS, because they don’t investigate real cases of child abuse, even once the medical evidence of the abuse is handed over.

      At your last appointment with your now “dangerously paranoid schizophrenic” psychiatrist, he will try to convince your husband that you need to go back on all the drugs that had made you sick previously. Have your husband not respond to these insane recommendations by the doctor, requiring you to remind the psychiatrist that each drug had made you sick, and you are doing much better off his drugs. Comments with which your husband agrees. The “dangerously paranoid schizophrenic” psychiatrist will finally chime in with gossip, since his “paranoid schizophrenia” resulted in his going back to talking to the other doctors, for gossip he can use against you. “You left your church! Wow! That’s big news!”

      Roll your eyes, and look to your husband, but have him not respond. Then tell the “dangerously paranoid schizophrenic” psychiatrist that you’d left your church months ago so it was not even “news.” Then stand up, ask “Are we done,” and walk out. This will be recorded in his medical records as “VERY CAREFUL STYLE!”

      The “dangerous paranoid schizophrenic” psychiatrist will then ask his receptionists to get you to sign a sheet full of clear stickers that state on them, “I declare this is true.” Tell those receptionists that if they’d like to go through the medical records and place the stickers in the medical records where they want confirmation of the truth, you will sign them, if the information in the medical record is true. They will decline, because the entire office is filled with other patients watching what’s going on. And you walk away forever, well except to come back for copies of your medical records, to “give to your next doctor.”

      Don’t go to another psychiatrist, go to a different doctor, and ask to be weaned off the last drug. That doctor will want you to go to another psychiatrist, politely decline that recommendation. That doctor will then refuse to treat your family, recommend you change insurance groups, but also refuse to prescribe that last drug. And, you’ve finally been weaned off all the psychiatric drugs by doctors. Change insurance groups and find another new doctor, but do not hand over your medical history this time, and avoid medical care as much as possible.

      If you are dealing with a medical/religious “conspiracy” to profiteer off of covering up the rape of your child, your religion will sick more “mental health” workers on you, seemingly endlessly. Like this now arrested and convicted one.

      https://www.justice.gov/usao-ndil/pr/oak-brook-doctor-convicted-kickback-scheme-sacred-heart-hospital

      And ethical pastors in your religion’s main synod offices will write books about the disgusting child rape covering up and profiteering hobbies of the head bishops within your religion.

      https://books.google.com/books?id=xI01AlxH1uAC&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false

      Other religions will warn their employees about these systemic child rape covering up crimes of your former religion.

      https://virtueonline.org/lutherans-elca-texas-catastrophe-coming-lesson-episcopalians

      Do your medical research, make sure you find the medical evidence of how you were made sick. Thankfully, Robert Whitaker pointed out the completely iatrogenic etiology of our society’s antidepressant induced, “bipolar epidemic,” which is how I was made sick. And I found the medical proof that the antipsychotics can create “psychosis,” both while on the neurotoxins, via anticholinergic toxidrome, and when weaned off of them, via a drug withdrawal induced “super sensitivity manic psychosis.”

      https://en.wikipedia.org/wiki/Toxidrome
      https://mentalhealthdaily.com/2014/04/16/can-withdrawal-from-antipsychotics-cause-psychosis/

      With this information in hand, it limits the options for the psychologists from your child rape covering up former religion. So a psychologist from that religion will try to give you an award, after seeing your “truthful” artwork, and hand over an “artist manager” contract. Which is actually a gross profit collecting, “I want to take all the profits from your artwork, eventually steal all your ‘too truthful’ artwork about our religion’s crimes against your family, plus take control of all your family’s money, your accounting affairs, and take away all your legal rights” contract. Don’t sign the contract.

      The religions, and their way too intrusive “mental health” workers, are staggeringly persistent in wanting to maintain their “dirty little secret of the two original educated professions,” scientifically “invalid,” primarily child rape profiteering, iatrogenic illness creating, now multibillion dollar, fraud based “mental health” system. Which, of course, is bringing in big profits for the religious hospitals.

      https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml
      https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
      https://www.madinamerica.com/2016/04/heal-for-life/

      I’ve got a better idea, I think our country should start arresting the child rapists and child traffickers. Especially, since our “mental health” workers’ systemic child abuse profiteering system also aids, abets, and empowers the child harming criminals to the point we now have “epidemic” levels of child abuse and child sex trafficking.

      https://www.washingtonexaminer.com/fbi-epidemic-levels-of-pedophilia-child-sex-trafficking
      https://www.youtube.com/watch?v=-nzi2avrKDg

      I think the “mental health” workers should stop aiding, abetting, and empowering the child rapists, by turning millions and millions of child abuse survivors, and their family members, into the “mentally ill” with the psychiatric drugs. I think now that we all live in the information age, it’s time “the dirty little secret of the two educated professions” should end.

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  8. My goodness, Ms. Morrill, this self-important, naval-gazing, “studying”, “examining”, & “analyzing” research is darkly hilarious.
    All this verbal mincing around the client’s “lack of opportunity to make explicit requests” is insulting to many in the ‘trenches’.

    With respect…and real-life insight gained from 11 years of private & state-funded psychiatry, coast to coast…may I suggest you apply your study of “the impact of social violence” directly to the topic of this specious little report.

    Were you ‘just sharing’ or do you think this tepid, pearl-clutching is significant somehow to anyone outside of the zone of academia?

    The interaction in most appointments is NOT a dry, polite exchange (as the previous Comments attest), it’s a regular mugging, an assault on client’s rights, health, & short & long-term safety; shrieking, contorting, on-your-knees suffering.

    This article’s attempt at sanitizing this “social violence” (your field) at med checks in the name of mental health care, is mightily offensive. There is no respectful listening to a client, no responsive actions taken, just ‘cost & liability’ considerations.
    Side effects are authoritativly declared trivial or (clients ALL know this by heart)-SYMPTOMS. And that’s a Full Stop.

    There, mystery solved….now ‘study’ how to, psychologically of course, supress the conflict-of-interest gene in psychiatrists; nature or nurture? Talk among yourselves.
    We’ll be waiting right here.

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    • The best situation for a psych test subject to be in is where they thoroughly deceive the deceitful abuser. Kiss up to them. Never complain about “side effects” since they don’t care and are capable of doubling or tripling the drug making you deathly ill as an act of petty revenge. Absolute power does that to people.

      Flatter them nonstop. Like a rape survivor I heard who tricked her captor into thinking his kidnap and rape had made her fall in love with him. He took a shower and she escaped. Pretty stupid to think his cruelty would win her undying love and loyalty. But a surprisingly large number of power-crazed people think that way.

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