There is a term in the recovery movement called "the medicalization of mental illness," which is known in disability studies as "the medical model." In this model, the doctor is the omniscient expert, the doctor identifies the pathology, the doctor prescribes medication for the illness, the patient does what the doctor says, and the patient is cured.
The problem here is that with mental illness, no one really knows definitively what its etiology is / what causes mental illness. The prevailing theory of etiology is that somehow the brain's chemistry has gone awry which informs our prevailing treatment these days -- correcting brain pathology chemically with medications.
However, there are 54 identified (so far) neurotransmitters in the brain. Think of the potential permutations and combinations of brain chemistry. Antidpressants supposedly act on neurotransmitters like serotonin or dopamine, yet the most prescribed antidepressants and their manufacturers admit...that the "method of action is unknown." Even the pharmaceutical industry writes in the fine print "we don't know what these drugs do to the brain."
Science is in its infancy in terms of our understanding of the brain, yet we proceed to "cure" with relative certainty. We really have no idea how these medications work, if they will work, or what the long-term impact of medications are on the brain.
Etiology informs treatment. This is why I asked you to articulate what YOU think causes mental illness.
If we can't say for sure what causes mental illness, why are we looking to cure mental illness with medications -- despite not knowing how they act on the brain? If we think MI is caused by genetics, are we researching gene therapy? If it is caused by trauma, why aren't we focusing on love, support, and unconditional regard for people who have trauma in their backgrounds? If etiology is complex and multivariate, why aren't our approaches to diagnosis and treatment?
Questions for replies:
Why is there such certainty within the psychiatric community about medications as treatment? we know first and second generation neuroleptics CAUSE brain damage, and some research indicates that negative effects of newer meds are systematically downplayedn(perhaps due to profit motives). Why are clinicians so SURE of their diagnosis and medications for treatment? Walter Freeman was sure, too....and in hindsight...was his cure what was best for folks?
I think that there is so much certainty coming from the psychiatric community about medications because they have seen results from patients. They have seen the medications “working” and causing a quick fix or “cure” to mental some mental illness symptoms. I think it is the easy way out for the psychiatric community- medications are easily prescribed and easily taken. Often times there is a trust created between patient and doctor, leaving the patient vulnerable to doing/ talking whatever the Doctor advises.
ReplyDeleteI completely agree with you Erin. I feel like we get wrapped up in believing that our doctors know what is best and therefore we listen to their advice with little to no question.
DeleteTo go along with both of your comments about getting caught up and trusting our Doctor to make the best call for our health, it's so critical we ask questions and do research before taking a prescription now a days..
DeleteI honestly do not know why clinicians are so sure of the diagnosis and treatments that they are giving to patients. My opinion is that it lies in the category of money. I do not see nor do I understand how you can appropriately treat something that you have no idea how it is caused. Of course there are trials on medications to test for improved symptoms, but how is that an adequate determination for all individuals? Again I feel that the root is money and that alternative treatments are not explored as they should be. I worked at a doctor’s office for many years and every day for breakfast and lunch drug representatives catered the meals. They did this so they could speak with the doctors about the medication that they were representing. The doctors would prescribe that particular medication more often and in turn their relationship with the drug reps became fruitful. The common bond between the two was the money they were both receiving not the patients well-being.
ReplyDeleteI think the psychiatric community’s confidence in drugs has more than a few root causes, and is fed by untold numbers of cultural and institutional practices. But I’ll focus on the mental health field, and say that I think the number one reason is tradition. Medical health professionals (especially those who have the exclusive right to prescribe psych meds) go through years and years of training with a rotating cast of professors, nearly all of whom tout the benefits of these drugs while minimizing the harm that they do. Another tradition of the Western medical world is the infallibility of the doctor; he knows best, right? Doctors are trained to stay emotionally removed from patients (so they’re more likely to look at drugs with regards to statistics – how likely negative effects will occur instead of how terribly those effects could harm people). Also – I think this was touched upon in our reading – by giving psychiatrists the nearly exclusive ability to prescribe these medications, we give them the means to ensure their job security. So long as mental illness is incurable, but can be “managed” with ongoing prescriptions, psychiatrists never have to worry about going out of style… especially since so many drugs (like Ritalin, which is like the 34th best-selling drug in the world) are highly addictive. Also, if you went to college for years and years and you really believed in the good work you felt was being done with psychiatry, how difficult would it be to take a good hard look at the field you dedicated your life to and agree that it’s not as important, or helpful, as it claims to be? Ouch, right?
ReplyDeleteI think there is such certainty within the psychiatric community about medications because it’s still new and we haven’t seen long term results from medications. I feel that we’re despite to find a cure so when suggested that we try a new medication that has been put out by the pharmaceutical industry we’re so eager to give it a try that we convince ourselves and exaggerate how much it’s helped.
ReplyDeleteClinicians are so sure of their diagnosis and medications for treatments because they are confident in themselves, almost too confident if you think about Walter Freeman. If a medication has worked for someone with similar problems, doctors seem to push the fact it will work for them. I think Walter Freeman went too far and thought too highly of his work, he seemed to have the idea that if you've seen one case/person, you've seen them all and just assume the same solution would work, which in his case was performing a lobotomy of some sort.
I don't think that there is certainty. I think it might appear that doctors are confident in their prescribing of psychological medications, but in reality, its just a game of hit or miss. When one thing doesn't work, they try something else. In some cases, the only things that work are first generation antipsychotics. Having seen first hand multiple people who have schizophrenia, usually at the point of their "mental break", there is no other treatment option other than medication. You can't communicate with them, you cant pull them out of whatever hallucination or world they are in inside their brain, so counseling wouldn't help at all. Real genuine psychosis is not something that you can just give them a safe environment and hope it'll go away. Psychiatrists prescribe what they have been taught to, to people with certain symptoms. They have as much confidence in their abilities as a regular doctor does in giving someone with pneumonia an antibiotic. It might work, it might not. If it doesn't, we'll try something else, perhaps a little stronger.
ReplyDeleteWalter Freeman performed lobotomies on patients with behavioral/psychological issues, because at the time, that was what practitioners did. When they found that medication could have similar results, lobotomies became obsolete. I also think that he pushed for lobotomies because he was doing 75 of them a day at 200 bucks a whack.
I'm not sure that medication is the only option for people who are experiencing flagrant psychosis. Often there is so much fear (paranoia) and distrust -- and some of that is warranted, given forced treatment and commitment by family members. In a later module we will talk about the importance of 3 main ingredients in recovery: Hope, meaningful activity (a reason to live), and the presence of at least one other person who believes in "you." -- I've seen far too many people, paralyzed by fear and psychosis, held down and forcibly medicated. It is quicker, but the price we practitioners pay in terms of lost trust, impacts our ability to help in a negative way. People, survivors of psychiatric services, often have good reason to be paranoid, and we have to recognize their fear and trauma and their humanness...even in the midst of their psychotic episodes.
ReplyDeleteHeld Down and being Forced to take a drug seems so inhumane to me, theyre has to be a better way to administer drugs to these patients. Once Trust Is lost doesn't it become harder to get patients to do whats best for them?
DeleteMedications are a "quick fix", and I think that is why doctors are so quick to prescribe them. There are many medications that have negative effects on the human body. Medications can cause psychosis, blood clots, infections, dizziness, death, and many more. There are studies done comparing those who have depression who aren't are medication and those who have depression that are medicated. In most cases the antidepressants enhanced the depression, and those who attended therapy without medication recovered. Being in the mental health field I see some clients who "need" medication, and are better on them. I have also seen many cases of clients who are over medicated, and who would do better without it. For now medication is a good solution for some people, but I believe there are better alternatives that are yet to be discovered.
ReplyDeleteClinicians are rarely certain of diagnoses. We, in the realm of psychology, often hear of patients being misdiagnosed by doctors. Because of this misdiagnosis, they receive the wrong treatment (usually in the form of medications) and this can end very badly for the patient.
ReplyDeletePharmaceutical companies do play a huge role, I'm sure, in the overprescription of medications. People genuinely do seek a "quick fix" as many feel that psychotherapy takes too long. They want to feel better and they want to feel better now. Pharmaceutical companies provide the quick fix in the form of drugs, which are available and easily administered.
It's really rather unfortunate that there is such a push for clinicians to prescribe medications for patients rather than seek other treatments that may be more beneficial to the patients. Or if prescriptions are the quickest fix, clinicians should work towards weaning folks off of medications and onto a therapy regimen that could be more beneficial in the long run.
I honestly don't think that there is real certainty about medications and treatments within the psychiatric community. I think they're deceiving themselves because, not only is it bad for the pharmaceutical companies profits, but because it can make the doctors look bad. It seems to me that the psychiatric community is so worried about how it's viewed by other medical communities and just society in general that it refuses to admit mistakes, even at the expense of the people they are supposed to be treating.
ReplyDeleteI don't know if the denial of failed treatments is simply because of greed or if it's because of pride, but I think it needs to stop. Regulations should be put in place that keeps the pharmaceutical companies out of the testing processes so more honest results are presented to the medical communities and the public.
Why is there such certainty within the psychiatric community about medications as treatment? we know first and second generation neuroleptics CAUSE brain damage, and some research indicates that negative effects of newer meds are systematically downplayed and (perhaps due to profit motives). Why are clinicians so SURE of their diagnosis and medications for treatment? Walter Freeman was sure, too....and in hindsight...was his cure what was best for folks?
ReplyDeleteI feel that because there are only certain drugs available and noted as beneficial the psychiatric community has accepted the drugs as a common treatment. And no one has or is looking for a better option. I think that because the previous treatment once found humane and beneficial are now illegal or widely unaccepted. Doctors have now accepted medication as the best treatment. It all goes back to Etiology what we think is the cause, and then in reaction the best way to treat this cause. In today’s world medication is the best treatment. In the future we might theorize a different cause to different mental illness’s, and in reaction a new method of treatment. We know that these drugs are harmful and cause brain damage to patients, however the manageability and demeanor of the patients has been proven better, even if the patient themselves is not physically or mentally healthier. I also think that doctor’s as a whole want to help people and when doing research want to find the best new treatment. And that being human can create bias toward their own drug and it’s “minimal side effects” Also research cost money and it is hard to report failure and easier to report success.