Saturday, December 26, 2009

To Medicate or not to Medicate, that is the Question 1

We have all read of the Anti-Psychiatric Movement with its glaringly obvious condemnation of the over-prescription of anti-psychotic and other pharmaco-psychological drugs. This is an issue that touches us all intimately. After viewing the recent statistics available at a reputable site who could disagree that this topic is extremely relevant. The prevalence of depression in the USA is estimated as "5.3% adults (USSG); 17 million people; approximately 4% of adolescents get seriously depressed (NIMH); annually 12% of women ; 7% of men; lifetime risk of an episode for women 20%. 3-4 million men USA." (Quoted from this link here STATS and accessed on December 26, 2009, 23:21 GMT)

Anti-psychiatry is now quite a dated term used to refer to a configuration of groups and theoretical constructs that emerged in the 1960s and were considerably hostile to most of the fundamental assumptions and practices then and still current in psychiatry. Its igniting influences were Michel Foucault (1926-1984), R. D. Laing (1927-1989), Thomas Szasz (1920- ) and, in Italy, Franco Basaglia (1924-1980). The term was first used by the English psychiatrist David Cooper (1931-1986) in 1967. Some now prefer the term critical psychiatry to avoid connotations that may appear oppositional merely, though the two concepts are distinct.

These critics and today their contemporary colleagues-in-arms argue that (i) the specific definitions and criteria for various psychiatric complaints (as promulgated in the DSM) are extremely vague and even arbitrary, thereby leaving great elbow room for clinicians to diagnose what they consider more likely, rather than basing their conclusions on the rigours of more scientific criteria. They also argue that (ii) psychiatric interventions are often more harmful than helpful to patients. Other key arguments have been the fact that the psychiatric profession has (i) overused and over prescribed anti-psychotics and anti-depressants and other drugs, (ii) have ruled out or are exceedingly sceptical of alternative or complementary approaches, (iii) the abuse of authority and power with respect to patients and their families and (iv) the compromising of medical ethics by alignment with certain pharmaceutical companies and insurance groups.

From my relatively narrow study of psychotherapy over the past number of years, it would seem that Dr. William Glasser, the founder of Reality Therapy belongs firmly to the anti-psychiatric group. Reality Therapy is an approach to psychotherapy and counselling which was developed by the psychiatrist Dr. William Glasser in 1965. It is based on choice theory (originally called control theory). It has become well-established in the US and internationally and it has also been widely applied in education. It also has a strong foothold in Ireland. Its anti-drugs stance in psychiatric complaints is quite delimiting in my opinion, and I speak from personal experience.

What's needed in psychiatry is a holistic approach, a "both/and" approach, not an "either/or" one. I suffer from clinical depression of the unipolar variety. I went through several extremely disturbing bots of depression before I was properly diagnosed. Since then, some twelve years ago, I have devoured as many books as I could on the subject. The one which most appealed to me was was called Malignant Sadness by the atheistic biologist, a wonderful scholar, Lewis Wolpert. I cannot remember if I reviewed that book in these pages as I read it some ten or more years ago. It is full of science and explains the whole psychiatry thing in a biochemical fashion. I loved it, because Lewis Wolpert wrote with scientific knowledge and a passion and a certainty I did not find in other books. He also described my own peculiar symptoms, which I shared with him, in precise detail. I also learned that many patients spend years trying to get a proper diagnosis because, while there are many common early symptoms, there are also ones peculiar to the personal chemistry of this or that individual. Anyway, psychopharmacological intervention helped me and continues to do so. It's at my peril that I discontinue my medication...

It's a long story, which I cannot summarise in full in this wee post, but which I want briefly to allude to. The central distinction for me is the distinction between Reactive Depression and Endogenous or Clinical Depression. After being hospitalised for some seven weeks after a particularly frightening breakdown, my consultant psychiatrist had diagnosed "reactive depression." Even though, I was adamant that I was not suffering from depression of the reactive variety, I bowed to the superior knowledge of the wonderful consultant who was responsible for my getting better. Why did I not believe that I suffered from reactive depression? Well reactive depression results from a negative reaction to one's work environment. However, I knew well that, while I certainly suffered from the normal stressors that go with teaching - belligerent or defiant students now and then - I certainly never hated teaching. In fact, I loved it and enjoyed the verbal jousting and even boisterous interaction of every class, good, bad and indifferent. Therefore, while I was well, I still doubted the diagnosis. In line with his diagnosis, the doctor withdrew the anti-depressants gradually over the following year while recommending counselling and psychotherapy which I did attend. However, lo and behold, when I was off the drugs for a number of weeks the depression returned. This time, I found that I did not go quite as deep into the pit of desolation as I had the first time, but rather on this occasion I went down a certain depth, but disconcertingly remained down there for a longer period. This time, while the experience was not as violently agitating, it was more disturbing insofar as it was impossible to see any light at the end of the tunnel.

To make a long story short, after twelve weeks of experimenting with this and that drug an appropriate one was found. For the last twelve years I have been well and medicated, and have only missed two days from school in that long period. For me, this is the success of pharmaco-psychology. However, I readily admit that I also look after myself and do attend courses on self-development, have gone to therapists and counsellors, and general keep myself mentally and physically healthy as best as I can.

Let me talk about a few other cases I know. A friend of mine, who is 55 years old is also on the same medication as I. However, he has reactive depression. He goes on and off this medication after attending his G.P. when he feels depressed or under pressure. I have told him often that this is the wrong way to go. What he needs is psychotherapy or counselling to deal with the obvious environmental and psychical stressor namely post-traumatic stress after a rather violent attack on himself by an armed robber at his business premises. This brave, if silly, man went back to work that afternoon as if nothing had happened to him. From that instant he could trace his bouts of depression. Fine, for this gentleman, the drug therapy is necessary to calm him down or decrease his depression or anxiety. However, he needs concurrent and post medication counselling. Such on-going counselling will eventually allow him to never (or only very seldom) have to use those antidepressants in the future.

Another worrying case is that of a special needs student in my school who is extremely weak and has Asperger's Syndrome coupled with a recent diagnosis of crippling OCD. He is extremely anxious at all times and is heavily medicated. Well the psychiatrists and psychologists say that they cannot do any CBT with this young boy until the meds have kicked in. His case is complex. However, as a teacher who has studied psychotherapy for some years and as a medicated and "cured" sufferer of endogenous depression, I feel that his problems are more deeply rooted in the human condition. My preference for Rogerian Psychotherapy or Person-Centred and the more existential approaches of the likes of my current guru Irvin D. Yalom suggest to me that this boy is suffering from an angst or anxiety of high intensity - sheer existentialism to the nth degree. My diagnostics in numeracy, communication and language and in literacy show him to be operating at a second or third class primary level. My contention and that of his Special Needs Assistant is that his anxiety comes from the fact that every day that he walks into class he feels inferior or worse, he feels that he is an uncomprehending nobody, an insignificant little thing who can understand nothing of what's going on. No person should have to feel thus, much less a young adult. His mother has rung me in a distraught condition about her son's anxiety which shows itself in considerable anxiety and agitation at home. He can shout and roar and protest. The poor lady videoed the poor lad on her mobile phone to show us and his psychiatrist and psychologist his sheer distress. The SNA was disturbed and so was I to a lesser extent. (Remember I have spent 7 weeks in a psychiatric hospital and have also counselled some people in my time as well as helping calm agitated souls.) The SNA and I feel his troubles are of the reactive existentialist variety rather than of the endogenous variety. So putting him into class may not be a good idea if that's what's causing him to stress out. The quandary is that now this poor boy is highly medicated for anxiety and stress. Are we treating symptoms rather than the underlying problem? Therein lies the crux of the matter.

To be continued.

Above a tree "lives" in Death Valley, California.

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