Laziness Wins
Although my therapist neglected to tell me the most important information I have ever learned – EVER, I do admire him.
He recently told me a story. A clinic opened near his office and he decided to try something new. He sent letters to the GP’s introducing himself as psychologist and sent along his impressive resume. He suggested that they set up a relationship wherein if a doctor has a patient who comes in looking for a depression med or thinking that he/she might benefit from one psych med or another, the GP refers the patient to my psychologist to interpret the actual need.
He is convinced that GP’s are the worst offenders of prescription writing before they know the full story. They are swayed by drug reps who visit the office and leave samples. There is too much information for them to really know the full description of med interactions and side effects of all the generations of psych meds on the market. I have written about this before but it bears repeating. There are too many psych meds coursing through our country’s blood stream.
My friend with the son whom I have written about so often was given a prescription for an antipsychotic after her son had a twenty minute evaluation. He was thirteen. (Off-label use on children… Give it to him! It will adjust his mood!). She didn’t. But, how often is this happening? How many times a day are children receiving meds for ADD? The life-long trajectory of drug use is spelled out. Ritalin first, onto depression meds and, when more control is needed, the big guns – antipsychotics are added. It was never mentioned to my daughter that the depression meds might cause mania. She found that out on her own.
Anyway, not one of the doctors in the new office called my psychologist. Life is hard sometimes. It is tough to have a kid and give up your job. It is discombobulating to move. It is sad to lose a parent. It is hard to fit in another appointment, this one with a psychologist. And then there is the stigma attached to a visit to a mental health professional.
Doug Bremner, the writer of the blog, Before You Take that Pill, has a post today about Daniel Carlat. From the post American Shrinkery Update:
Dan Carlat MD has just come out with a book on American psychiatry that has got a lot of people talking. In Unhinged: The Trouble With Psychiatry – A Doctor’s Revelations About a Profession in Crisis Dr. Carlat describes the practices of the typical psychiatrist. In order to generate the most income, most of the appointments are 15 minute “med checks,” and the treatments are based on psychopharmacology and the biological psychiatry model. Patients are fed the pharma marketing explanations of how psychotropic medications work, providing solace for all involved, although there really isn’t good evidence for the explanations. Meanwhile, psychiatrists have farmed out therapy to the other professions, and have adopted a herd em through mentality toward their patients.
So, is the general public getting treatment when it is actually needed? I don’t think so. I think the quick and easy pill has taken over. When my daughter first experienced signs of anxiety, she was given benzodiazepines. Even over my pleas that the psychiatrist take time to talk to my daughter about drinking and combining drugs. The “med checks” were too short to get into it.
A friend of mine is battling the side effects of Effexor after trying it because a friend though it would be “good for her”. Her doctor wrote a prescription for it and sent it to the pharmacy. No appointment necessary.
If there is no such thing as chemical imbalance of the brain (the little thing my therapist neglected to tell me before I read Robert Whitaker’s book), what are all these drugs doing – other than creating life-long users of a corrupt system.
Is everyone is too lazy to change it?
good post Kristine and great questions. I have my thoughts but geez….conspiracy? That sounds like something that could get one another diagnosis and all credibility tossed out the window. Yet – if you look back on the history of corporate and government walking hand in hand as in the history and relationship with Big Tobacco…..something to look at I suppose.
I don’t think its “lazy”….and some won’t chooose to do the emotional work and others wont be capable for one reason or another – but a mechanic is not going to teach me to change my oil and risk losing my regular business. I was never given the option to not take meds or do the “hard work”. I was told it was “genetic” and biochemical etc.
Meds may have a place in many instances – but I believe that the true clear option to learn how to go through the emotional pain to get out of it should be an option vs the lifetime commitment to supporting the therapists and psychiatrists vacations and Mercedes.
This healing process is NOT as complicated as it has been made out to be by the system that needs us to keep their retirement funded.
Sorry for the sarcasm but in 15 years – my shrink and therapists took at least 2 vacations each year, drove imports and owned houses while I lost everything material and was drugged into oblivion so yup; I have some feelings around this issue.
Susan
Susan,
I don’t actually think that there is a conspiracy. I think where there is money, lots and lots of money, there is corruption. And, the psychiatrists and pharma and everyone in between (APA, NAMI, etc.) are benefitting from the piles of money pouring in. (And, this is not a victimless “crime”.) The part of this that irks me the most is that this amazing money-maker was built on the false premise that these drugs were going to change peoples’ lives for the better. Research reports were twisted to indicate better results than actually took place. The whole system was build on this shaky foundation.
You are very right that people do not want to do the hard work of emotional healing and would much prefer to take a pill. But, what if that wasn’t the first course of action? What if the medical model was different? What if you had to do some emotional healing in group and individual therapy before psych drugs were even tried?
So, used the word “lazy” to mean that it is easier to not “rock the boat”. My psychologist tried to change the system just a little bit and was ignored. it is easier. the drugs are plentiful and if one doesn’t work, the GP can write out a prescription for another without even having to see you.
I have mixed views on medication, which is why I haven’t commented on any of the medication related posts you have written, as I have been trying to think about what I have wanted to say. I am not anti psychiatry – I think that some people are helped enormously by medication – I have seen it happen with friends. One in particular, another blogger who has Bipolar, used to severely self harm and make very frequent suicide attempts and was tried on quite a few different medications, and then suddenly they found what seemed to be the right combination for her and her recovery was incredible – she is now going to university in September to train as a Mental Health Nurse. So she would be an example of someone who I think does have a mental health problem that can be helped enormously by medication, and I can think of other examples amongst bloggers also.
However, I think medications are prescribed far too easily – if someone goes to their GP and says they have been feeling down then they are prescribed anti depressants. In this country I don’t think it is so much the ‘big pharma’ conspiracy thing so much as GPs not knowing what else to do. Despite that though, from what I have read I think that medication is prescribed less, and probably more responsibly in this country than it is in the US. Children are rarely medicated – there are some kids who are on Ritalin for ADHD, but it is very much a last resort, after a very thorough assessment at home and school, as well as with mental health professionals, and if there is another option then that is tried first. Many parents go to the mental health services saying their child has ADHD and needs Ritalin, but a tiny percentage of those are actually diagnosed with ADHD and prescribed medication. There was a documentary on over here a few months ago called ‘America’s Medicated Kids’, which everyone over here found really quite shocking – there was one young boy who was autistic, and apparently also had ADHD, and because he had once threatened to kill himself (which he told the cameras had only been something he said and he wouldn’t have actually done it) he had been diagnosed with Bipolar and put on anti psychotics. That wouldn’t happen here.
I don’t really buy into the ‘Big Pharma’ anti psychiatry theory, at least for this country, because basically Doctors here having nothing to gain by prescribing any medication. So whilst GPs may dish out the anti depressants too readily, because if someone isn’t a severe enough case to refer on to specialist services they aren’t sure what else to do, I think that once you reach Secondary services (ie specialist MH services), and it is Psychiatrists doing the prescribing, then they prescribe much more responsibly. I know that for example BPD seems to be pretty heavily medicated over there, whereas here most people with BPD are basically only on medication if other MH problems are also diagnosed, so most commonly people might be on an anti depressant if Depression is also diagnosable, and sometimes a mood stabiliser, but that is nearly always only if Bipolar is also a diagnosis, rather than for the BPD alone.
I suppose my overall feelings are that medication can be helpful, and does save lives, but it needs to be prescribed responsibly and after thorough assessment, rather than dished out as an easy option etc.
I forgot to say – the other thing is that in this country nobody makes any money from medications being prescribed; in fact it costs the NHS an awful lot. Although there is a charge for prescriptions unless you are on benefits (ie not working) or are over 65, it is £7.20 per prescription, which doesn’t even nearly cover the cost of most medications – the NHS subside the rest of the cost, and in the case of people like me, who don’t work and are exempt from paying for prescriptions, the NHS pays the entire cost. And since the people on the most medications are the least likely to be working, this basically means that the majority of prescriptions are free, and so very expensive to the NHS. So there is no incentive for Doctors to prescribe based on cost, as actually it costs the government a lot of money, although neither have I ever heard of anyone not being prescribed something they should have (generally like antibiotics etc, or psychiatric drugs), so I don’t think there is any issue at all with Doctors not prescribing when they should to save money or anything.
I am going to check out the blog and book you mentioned. My son has been on a variety of meds since January and is still anxious, depressed, etc. I think he needs to talk about the root issue that is bothering him. I know what it is but he won’t talk about it. All the drugs in the world are not going to help him (possibly harm him) until he faces it.
Hi Bip,
I know that it is very different in the UK. Over-medicating is a real problem here in the States. I also need to write again that I do not completely disregard the idea of the use of psych meds. Maybe I should devote an entire post dedicated to this idea. I just don’t agree with indiscriminate prescription writing and life-long commitment to a combination of psych drugs. I think using them to stabilize is sometimes the only way to pull a person back from the edge.
In this country, Big Pharma dictates everything from insurance premiums to the small town doctors prescribing antidepressants to NAMI. They have their fingers in every pot. I just want to cut a few off…
Kris; I like the word you chose “corruption” is a good description of whatever this is that goes on. On the not rocking the boat – yes I’d agree. It is easier to keep the peace. As for the group idea etc….very often those who are leading any kind of groups are also dealing with and resolving their own issues via their work. So – a good idea but in my experience has not been helpful and is part of the problem as those charged with the “talk” part of the process are lacking the understanding of what is needed to “go through” to “get out of”. I had one psychiatrist that had some value to add to my journey but would not do “therapy” because she could not bill for it as she explained – her job is to do the 10-15 minute med checks.
And so we march on doing the best we can.
I totally agree. I have a friend who is a very loving foster mom to two boys. She cares for them as if they are her own even though they are in the system to be adopted as soon as suitable parents are found (she have 2 grown children and is not looking to adopt). When the 5 year old boy found out that he will have to leave my sister’s home he began to “act out” at school against other students and the teacher. He felt that his loving home was being taken from him. After being warned several times about his behavior and an episode that involved kicking the teaching and fighting another student he was sent to a mental hospital for children. After a 2 week stay he was returned to my sister’s home with 2 medications he was to take everyday. One was to treat ADD and the another one was to treat depression. The medications changed his life forever. He complains that they make him think “crazy” and feel like no one loves him. My heart breaks for this little boy who was once so free spirited and full of joy. I think it’s easier to dope children up with medications rather than send them to speak to a psychiatrist who may be able to help them deal with life’s disappointments.
Hi Shirley,
This is a terribly sad story that is being played out throughout this country over and over again. By loving parents who just don’t know that there is any alternative to the drugs. This young boy can be taken slowly off the meds and hopefully be saved. It will take time and consistent work with a therapist but he doesn’t have to be made to feel “crazy”.
It is easier for the parents and doctors to administer drugs. It is a quick fix compared to finding a competent psychologist for some talk therapy and providing uniform, steady love. Few people want to take responsibility – even loving parents. I wrote about this in a recent blog posting:
http://borderlinefamilies.com/2010/07/independence-at-what-cost/
We want to raise independent strong children. It seems at any cost.
Thank you for sharing your story shirley,
xx kris