9A few weeks ago I was invited to listen in on an online discussion regarding psychiatric medication. The panel included health practitioners as well as campaigners for change who had used mental health services themselves and had remarkable stories to tell connected to their struggles to become free of dependency on psychoactive medications.
It is an interesting area for discussion. Why do so many people end up on lengthy drug regimes? Why do so many desire to be free of drugs at a later point in time? Is it possible to eventually wean oneself off the reliance on powerful medications? Well, there are many structural obstacles to overcome. First, we have to recognise that the currently prevailing theories of biochemistry and neurological theories which attempt to understand and treat human emotional distress are the predominant model and have been now for forty years. Psychiatric training, apart from the necessities of empathic connection to clients who they are meant to serve, is almost wholly reliant on brain chemistry explanations, imbalances of chemicals which can be corrected using drugs. That was the school of thinking which trained the nurses and psychiatrists of the 1990s and 2000s and the one that is prevalent today. The story that the patient tells is largely relegated to a secondary role. The doctor is trained to conduct an interview, look for signs that he or she is trained to identify, using the scale of symptoms in the current guides, politely "listen" to the client and tick the relevant boxes for a diagnosis. Many patients intuitively sense this process when they are are being interviewed and "reviewed" and naturally, it makes them more guarded and cautious in their sharings with the health professionals who, quite often, they had not had any real chance to get to know in any meanigful way. They wish, often, for an opportunity to discuss their distress and the causes of it, if they are able to, but too often, in my own experience of hospital working for a decade, there was never enough real time for medics to listen to personal narratives and discursive stories that, to them, often made little sense. Too many metaphors simply spoiled the broth. And so the quick and easy diagnostic toolbox cut through all of that, gave folk a diagnostic label and allowed for the next recommended step, invariably drug treatment. And off we would go on the medication carousel. Of course, drug companies make a lot of money. The more mental distress there seems to be in a population, the higher the profit levels. I do not say this with any sense of anger or from a "Marxist" political perspective. It is simply economically true. Mental health is a very large industry, employing many thousands of people. The "customers" are the clients or patients. The "illnesses" occur in and reside within that general population. The remedies are provided and everything rolls along, largely unquestioned in the minds of the general public. Drug company shares are doing well, profits often in the billions, and those at the top of this pyramid of power are very well rewarded. In times of global challenges and collective and individual human distress on a large scale, I expect these industries to be busier and as a consequence, more profitable than ever. But does it roll along without a cost? Have you ever tried coming OFF a psychiatric medication? Have you experienced some of the adverse side effects while using them? I talked with a friend, a doctor in Wales, United Kingdom. He told me that he was in a sort of perpetual bind. He knew a little of side effects from drugs that he prescribed, but had not looked at any literature on discontinuing a longstanding drug regime. He told me that, when a person comes to see him, even if they can articulate the stresses and triggers in their lives that are causing them to struggle psychologically or mentally, he realised that there was very little he could do to bring about change in their social circumstances and ease their levels of anxiety and pain. On occasions, when he tried to prescribe social activities such as walking, joining a club online or learning new skills in a group, the patient made it clear that what they wished for was IMMEDIATE help. Something that worked. Something that could make them change the way that they were feeling. They wanted a pill and they needed it now. Please, And so he would sigh and scribble out a prescription, doing all the right things, warning them to be alert to side effects and agreeing to come back in after a short while for a meeting and a case review. Maybe then, if things had gotten better or stabilised, the drugs might not be deemed as so necessary. At least they could talk about it. But he told me that it was quite a rare occurrence for anyone to ask for support to stop using them. Even if things had improved a little in their lives and they were more settled and stable in their feelings and thoughts, they often attributed some unmeasurable power to the medication itself. And who knows? Maybe they were right. This doctor was always a cautious prescriber of drugs. He tried to find other solutions and helpful remedies to help an ailing client before reaching for the pill prescription pad. But it was difficult to refuse a medication to someone who could say that their sister or a friend was using it already, so why not them? They felt that they were excluded unfairly from access to something that was already in use as a treatment. Why did they bother paying taxes? they would ask, if only to be denied the help they clearly needed? It felt wrong. He also had little time to spare in appointments and a large patient case load in a small but busy town on the coast. Reluctantly, he told me, it was easier to write it up, hand it over and get on to the next patient. It did not make him happy in his work. So there we see some of the difficult dynamics, the built in structural obstacles facing all the participants in mental health provision and service delivery, the dependence on powerful drugs, the lack of time for enquiry and exploration, the pressures placed on providers and the expectations and anxieties of the public. Now, of course, we have groups who have aligned themselves around the struggle of becoming free of psychiatric drug dependency. We also know that there is research which indicates that people using meds for many years may have their span of life shortened quite dramatically. Not all, but some, and some are still too many. This is a subject that is often undiscussed, by medics, or the general media and rarely gets a mention in medical journals or drug company magazines. Maybe it is seen as a story they do not wish to be told. People are also advised by some doctors that certain conditions mean that they will be on a drug regime for life. I have witnessed this at first hand when I attended care meetings alongside patients and supporting them to have their voices heard regarding treatment in British hospitals in the 1990s and through the 2000s. In one specific example, a doctor was well known among staff and patients as a "zealous" prescriber, and it turned out that he was also being paid a "bonus" for each patient he placed on a relatively new drug which they were trialling for people diagnosed with schizophrenia. He was also given an annual "working holiday" in Barbados, courtesy of the pharmaceutical company and which lasted ten days. He golfed a lot and was expected to give a salutary talk at a conference where he could praise the efficacy of the drug in front of an audience. If I recall, he was a "thought leader" for them, and paid other bonuses to talk to colleagues at work, exhorting them to consider prescribing the same medication to their own clients, in turn increasing drug company profits and boosting his own bank balance and suntan simultaneously. On one occasion, a patient was a 19 year old student from a wealthy, middle class Scottish family who told me had had briefly heard voices after smoking high grade marijuana and playing "World of Warcraft" on his computer for three days without any sleep and only drinking coffee. I asked myself who would not be hearing some voices after that? Often voice hearing is temporary for many, thank goodness, and in response to stresses and strains. We managed, after several meetings, to challenge the diagnosis and get him discharged home after a week on the ward, which he found quite a sobering and frightening place to be and told me he was determined to never return. And very thankful for having an advocate to support him on the journey. Well done NHS Scotland for providing an essential service! In my next piece, we will take a look at the challenges connected to safely getting free from psychiatric drug dependency, the experts by experience who are leading the way, the opposition forces that resist and decry it. Best wishes for now, Ivan
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July 2021
AuthorActivist/ Health worker/ 20 years. Specific interests : wellness/ voice hearing/ coping/ exploring/ sharing/ stigma reduction. |