Wednesday, May 25, 2022

Comments by MadnessCivilization

Showing 8 of 8 comments.

  • Proper informed consent and respect for an individuals agency and right to make the ultimate informed decision seems to answer most questions. If I know the harms (the full extent), potential (even rare) risks, and these harms and risks are given the same level and weight as how I may benefit from a medication; then it is I that has full agency to decide. The current system fails as it attempts to move those labeled ill back towards what society deems respectable (generally, generating economic activity).

    Still, even if we accept as utterly arbitrary the labeling of mental illness, and note its social construction (the Crux of Foucault’s Madness: The invention of an idea, a novel I recommend to anyone unfamiliar) medication as a choice is ethical. We have created a tool that does something (well, some of it), and we should have some right to attempt to utilize any tool we deem fit. We should always have equal right to refuse any tool, and have the most honest and well rounded perspective presented before we decide.

    A drug based model allows discussion of what the substance will actually do, eliminating the theoretical pseudoscience about brain chemistry. For example, rather then some convoluted and poorly researched theory that stimulants “function differently” in the brain of someone diagnosed with ADHD, a doctor might explain that the child struggles with cognitive tasks involving sustained attention, and one option might be utilization of a powerful stimulant, which will have x set of effects other then simply increasing attention, a mid-high risk of dependence, and x side effects. Far less people would choose medication in this world, and the one’s that did would be making the best informed choice they good within their personal context.

  • There is immense truth to the idea of substance dependence being mistaken for medical need of a substance. I am acutely familiar with this occurrence and agree it is of clinical import; however, this is not the experience to which I speak.

    I will leave my argument as it stands, except to say that in this particular reply to my thoughts; you seem to fall into the logical and ethical trap that psychiatry so often suffers from: you are fully confident you know the subjective experience of everyone else. When we say that the meds are harming us, most doctors reply that it must be our disorder. However, in this instance, you attribute any instance of one finding effective use in a medication to substance dependence. Especially with regards to focus, I argue that myself and many others are able to notice that the substance is an effective and costly tool. To speak from my own experience, therapy was ineffective as a young child because I was not open to it. Even at a young age, I had an awareness then being on medication was less then ideal (and others would benefit from a similar attitude from their doctors) but that it assisted me in a way that was worth the cost (to me, and my parents) at that time. I’m not claiming this is true for everyone, but I am also aware that I am not alone and that my experience is accurately reported and valid (as it is, my own subjective reality). Another individual comes to mind who suffered with crippling anxiety/panic attacks for decades, despite extensive and varied therapy, and other holistic techniques. In the end they found benzos (the drug class I happen to most disdain) provided relief from the psychic pain, and despite a full accounting of the risks and debilitating long term effects decided they would take the (temporarily) increased quality of life even at the high asking price (long term symptoms). Many years later they have achieved goals they never imagined, and have no complains.

    I issue this reply more to assert the need for us to always remain open to all experience, and never assume we know more then the individual whose experience it is.

    You are bringing light to critical issues that I don’t often hear discussed by those practicing medicine, despite my philosophical disagreement, I respect you deeply for it. And I thank you for engaging me in this discussion, I have found it enjoyable, and stimulating.

  • I guess i’m not certain why young children are administering, or even have ready access to their stimulant medication.

    For me it all comes down to an utter lack of effective “informed” consent. When we pose something as a miricle cure, it gives people no reason to worry. Due to the changing nature of medical liability, I have noticed many doctors are now extreamly honest about the risks for chronic benzo prescriptions (many still remain in the dark ages). Some will readily inform patients of addiction rates, and the mid-high risk of discontinuation symptoms even from low dose, chronic use.

    I hear everyone’s tragic stories, and I feel them deeply. There is a photo on the wall of my office with the picture of my brother (chosen, not blood) who I will never see living again. I feel the pain of his loss each, day and the anger at his doctor.

    However, I will always believe in choice. The calculus is somewhat different with children, as the parents make the primary choice (and I do feel that it is unethical, and immoral to force children to take meds they don’t want). I suppose I place my trust in people to make the choice that is right for them, at least a fair percent of the time, when given all the information.

    If the doctor presents medication as a tool, as an option, alongside other options including therapy, and even acceptance, many of the concerns I have seen mentioned vanished. If SSRIs were presented as a drug with about as much positive as negative efficacy research, with powerful discontinuation effects, and mid-high level risk of adverse reaction, I don’t imagine many would utilize the tool. This has happened with opioids during the epidemic, more and more doctors are providing accurate information, and posing a choice post minor surgery/injury. Many of my friends and colleagues now find themselves saying no thank you to pain medications that a few years ago they would have been asking for.

    Same applies to stimulants in my mind. We should be telling people that stimulants do not correct or cure anything, they are a tool, and one that should not be expected as a long term solution. They are a tool that enhances focus, at the (high) risk of abuse, (mid) risk of dependence, and an unpleasant discontinuation syndrome if taken too regularly. If we explained that they should be utilized as sparingly as possible, and not regarded as a daily “behavioral control” or “personality correction”. Finally, if we explain that there are other options, which may take longer to show results, but lack these inherent risks (therapy), I imagine we would see less people opt for stimulants, and more attempt therapy.

    I feel much of the legitimate concern is inherent to the status quo, where the medical world deludes people into feeling medication is the ONLY solution, and one must be unethical to refuse it to children. I don’t feel doctors have a place in pushing their views, but rather should, non-judgmentally, present the facts and research. I fear that many doctors in the psych world finish med school, and then limit their reading to publications from pharma companies, and perhaps psychiatric times (both provide a biased, limited perspective.) While havens for drug abuse advice, the primary SA harm reduction forums, especially Bluelight are a remarkable resource for exploring honest accounts of the real life effects of these substances, and should be regular reading for those prescribing the medication. The number of stories that begin with some form of “I had no interest in substances until I was RXed X substance” might make folks think a bit.

    But equally, the stories of those who have tried every solution, only to return to an RX that provides them relief when everything else fails touch me equally. I oppose painkillers, but also don’t feel one should be condemned to experience pain if they would prefer the risks of taking the medication.

    For me, it all comes down to the need for the medical field to provide accurate and well rounded information allowing for proper informed consent regarding utilization of these tools. We have the right to feel that chemicals are never the answer, we also have the right to every option possible.

    I respect everyone’s view, and prefer what everyone is saying to the current status quo.

  • Thank quick reply, I agree with your well extremely reasoned (and informed) view far more then with the mainstream logic regarding ADHD, and childhood prescriptions.

    However, in my personal and professional experience I have met many individuals diagnosed as “ADHD”, who, in my opinion, clearly lacked specific skills/coping skills. In these cases, I imagine therapy, or a radically improved education system, would easily replace the need for medication.

    I have also met many with this diagnosis, and others, for whom attention simply did not come without chemical aids. I myself achieved an advanced degree despite “pathological” issues with attention, not because I learned to attend in the rather “grey” classroom settings, but because I became adapt at gaining knowledge outside the classroom. This took maturity that no amount of therapy was able to induce in my younger self. Without stimulants, years of academic failure would have worn down my self esteem, had me taken out of the elite public school district I was attending, or both.

    I know many with similar experiences. I also fully understand and appreciate your argument, I recently lost a dear friend as a result of substance abuse. His substance abuse unquestionably began as a direct result of a (especially ludicrous) benzodiazepine prescription he was written as a young child. The risks of utilizing these tools is stark.

    However, I fear that an absolutist attitude towards their use (in either direction) risks failing to account for the subjectivity of our human experience. I feel a drug based understanding of these tools is critical to our ability to integrate them safety, only when necessary, and with true consent.

    I won’t go into my full view of how psych meds can be utilized effectively, as it is far too long. What I will say, with specific regard to stimulants, is there is simply no reason they should be given for daily use. Stimulants are not generally beneficial for anything but the most academic tasks (I don’t regard boosting physical energy reserves as the purpose of taking strong psych-stimulants). As such, they seem pointless on the weekends. Many subjective reports from individuals utilizing psycho-stimulants 3-5 times a week indicate no, or minimal discontinuation effects.

    And the doses are too damn high!

  • This use of the technique is almost difficult to term CBT, perhaps one should be clear if they are speaking about/using Beck’s CBT model, or another version. Beck not only opposed utilize his technique to coerce, I have personally heard him state that doctors utilizing psych meds in the treatment of depression and anxiety must be “unskilled”, as he only found these medications useful in (what he defined as) the early states of treating the most “acute” cases of depression. Even then, he did not feel the med treated the depression, but rather provided a window through the fog for his treatment to shine through.

  • I would argue anti-anxiety prescriptions to those under 18 are likely at direct fault for a higher number of substance related deaths.

    I also bristle at the idea at the attempt to labels others experience, my treatment with stimulants (while problematic) is also the only reason I got through many years of school. I ultimately took myself off the substance as maturity and coping skills allowed me to complete college and grad school without them. I would however, never have finished my early years in school without the medication that made it possible for me to sit through class.

    I may agree ADHD isn’t a illness as such (nor my diagnosis) but I will argue that it is a specific cognitive/biological category, and those fitting the category have a very difficult time preforming in classroom environments. Stimulants may have a severe downside, but so does dropping out of HS, or failing out of college (lets not forget the risks of poverty in this nation).

    If the argument is for a more fully discussed, drug-based understanding of why one might use or prescribe these substances, I’m in full agreement. However, if the point is meant to be that no one should ever utilize stimulant medications to survive/achieve in a classroom setting, I have to respectfully disagree, and support a subjective understanding of personal need/priorities and inherent dignity of risk.