Sunday, October 22, 2017

Comments by foglight

Showing 10 of 10 comments.

  • I do primary care in a public mental health clinic. Your article completely resonates with me. It’s frustrating because so often I feel like I’m working at cross-purposes not in tandem with the 10 or so psychiatric prescribers (MDs, NPs, pharmacists) at my site. Many of them are nice and well-meaning but caught up in the way of thinking you describe; several of them are arrogant, self-righteous and un-empathetic. I have one patient on 3 psych meds (not prescribed by me) who’s been stable for years who recently talked to me about wanting to slowly taper off one of his three meds, as a trial, with his ultimate goal being to get down to 0-1 psych meds. I thought that was a great idea & completely supported him. He was so hopeful; so proud of how well he was doing. But his psychiatrist is one of the horrid ones and completely squashed the idea when he brought it up with her, basically telling him he’d relapse and wreck his life if he changed his regime. When he came back to see me in primary care he was thoroughly deflated. The light had gone out of him. I don’t want to leave this site and abandon my patients because they need someone who cares for them as people and I feel committed to them. But I’m not sure how long I’ll be able to last in this setting.

  • Beautifully written. When I heard that Chris Cornell had died unexpectedly at 52, the very first thing I thought was “wonder which psych meds he’s on.” I’m a primary care NP at a (so-called) mental health clinic and it’s incredibly frustrating to see how many of the patients’ problems both mental and physical are exacerbated by their psych meds. But it’s hard to advocate for the pts with their psychiatric prescribers in a way that doesn’t make the prescribers defensive – after all, they have so few tools in their toolkit (basically only one: meds. Some of the social workers, on the other hand, are wonderful, being supportive in countless practical ways). Some patients who’ve been stable for years have told me they’d like to decrease or d/c their psych meds, and of course I’m supportive – but it’s wrenching to see them completely squelched by their psych prescribers when they bring up this possibility with them. “You’ll just go back to how you were – is that what you want??” (paraphrased). It’s so sad. The light just goes out of them. One patient who’d done great for years (hears a number of voices but lived fairly peaceably with them) was recently moved into a new board & care and she decompensated in the same way that an elderly person might due to a stressful new environment & loss of familiar routines. Would you drug your grandmother in a situation like this? Yet the response of her psych prescriber was, “She’s paranoid, I’ll up her clozapine.” It’s really hard to see.

  • I hardly think leaving a job after 35 years is “quitting.” Your framing your leaving as a result of having become disillusioned with the field of psychiatry feels dishonest to me. I’m sure as your job got more and more unrewarding and you’d saved up enough money to retire, you decided it would be more fun to continue writing your pop psychology books and speaking at conferences than seeing patients. Of course 15-minute visits focused on med management are stupid, but it’s not just psychiatry that’s sped up in a bad way in the past 15 years, it’s medicine as a whole, thanks to managed care, electronic health records, “productivity.” No-one in the medical field enjoys this or thinks it’s good for patients. I’ve been a primary care clinician for almost as long as you’ve been a psychiatrist, but in my scheduled 15-minute visits (of course I take longer than that with patients; I officially work part-time so I have time to work overtime) I have to not only be present for my patients in a compassionate way (yesterday I had to tell *two* patients they had cancer) and address their own health concerns – including depression and anxiety, often due to trauma histories – but also do paps and std checks, treat colds and skin issues and foot problems, address kidney failure and hypertension and diabetes and alcoholism and drug abuse. Psychiatrists are at the top of the medical hierarchy in a primary care clinic; as one psychiatrist I work alongside admits, “We have a cush job – all we do is sit and talk to people.” In most cases they don’t take vitals or pay attention to labs other than prescription drug levels. I agree that psychiatric “meds” are over-prescribed and have horrible side effects which lead to more over-prescribing, but I’m with the person who asked you whether you’d made it your mission to help taper people (aside from those few who are being helped) off some of these meds. That’s where i need help from psychiatrists. You put people on all these meds for years and years; I’ve had two patients kill themselves in frustration at not being able to get off benzos, and another tell me in frustration that their psychiatrist knew nothing about interactions between their psych scripts and alcohol/meth/crack/opioids. I’d love to meet a psychiatrist who decided to put their years of experience to use in a practical way that actually helps patients. Finally – Andrew Weil? Really? Celebrity doc, self-promoter, new age “guru.” I know doctors and nurses who’ve gone through the integrative medicine program in Arizona and learned a few things, but I’d listen to almost anyone on this site before I’d listen to Weil.

  • i hadn’t heard of him – will take a look at his work. according to yelp (!), he’s in his 80s now and still practicing in san francisco. his website kuninhealth.com lists a bunch of his articles – many on vitamins and/or nutrition, so nothing explicitly about getting off meds.

  • Thank you Naas for your testimonial. I’ve very happy for you that you were able to come off the meds after so many years of struggle and finally find the support you needed. I hate how nonchalantly many clinicians start patients on long-term psych meds with nary a thought given to how, when or if they’ll stop. I’m sure it will be a relief to finally have the time you need for self-care: healthy eating, exercise, repairing your teeth, nurturing your social connections.

    I’m a primary care nurse practitioner at a mental health clinic here in San Francisco, and I haven’t found other clinicians at my site (psychiatrists, psych NPs or pharmacologists) who are knowledgeable about or experienced in tapering patients off anti-psychotics or benzos, or motivated to follow up if the patient expresses a strong desire or interest in this. Do you have any suggestions for someone I could consult with or some online or printed resource? I’ve been trying to figure out for years how to help patients in this situation, even though it’s not officially my domain (I’m supposed to defer to the “mental health providers”). But I have yet to meet a prescribing clinician who has insight or expertise or even interest in this area.

  • So eloquent! You’re a beautiful writer, thank you. Your account gives insight not only into the abuses of the mental health system and how being caught up in the system affected you but also into the experience of someone going through such an intense, meaningful, and harrowing “passage.” Loved your description of your response to language during that time. I’m so glad you had a partner who validated your experience and stood with you. Having just one important person believe in you can make all the difference. I hope you’ll let readers on this site know when your book is finished!

  • You’re making a strong case for not missing the signs of catatonia, and for treating appropriately with benzos when catatonia is identified. But I’m left wondering: in Cora’s case, what was the underlying cause of her catatonia?? There are so many possibilities. It seems like simply identifying and treating the symptom (catatonia) doesn’t go far enough.

  • Thank you for this very eloquent account of your experience with benzos. I hope you do eventually write a book. I don’t know why the previous commenter (sonnyboy) is so unsympathetic when you clearly describe how months of sleeplessness while caring for two babies (and still nursing one – has sonnyboy tried that?!) drove you to desperation. You needed relief.

    I’m a nurse practitioner in a city where many of us work in “community sites” as well as in the main clinic. Several years ago I was assigned to do a weekly primary care clinic at a community outpatient “mental health center” replete with psychiatrists and social workers. One of the first patients who came to me, Mr D, was in anguish because of a Klonopin addiction of 12 years duration: he hated needing the drug, hated feeling like he was dying when he tried to get off it, hated that the psychiatrist he’d seen for anxiety 12 years ago had put him on it without informing him of the side effects, hated that his current psychiatrist thought the fact that he was still on such a low dose (“basically a placebo” per this MD) meant he didn’t really want to stop taking it. He was a very sweet man, and very unhappy. Since I don’t prescribe benzos, I turned to google for info on how to help patients withdraw, and came across Dr. Ashton’s work. But I felt like helping the patient with this myself was way beyond my skill/comfort level. Why aren’t psychiatrists trained to do this?! All the psychiatrists I approached at my clinic were useless (not to mention devoid of empathy – the good ones must be working elsewhere). Like Dr Kate, I told my patient I’d try to help him find an expert. Sad to say, several months later he committed suicide. To this day, when I read stories like yours I try to learn what I can do differently next time, for the next patient.