Tuesday, October 19, 2010

Getting Through - Surviving Mental Illness 5

To Medicate or Not to Medicate:  That is the Question

I have always been amused at how people, even very learned people like to take up opposing positions, and some are wont to rush to the barricades all too quickly.  I have long since tired of the debate between fundamentalist or extreme believers (in God, that is, whether they be fundamentalist Protestants, Catholics or the so-called more recently-named Creationists) on the one hand and extreme atheists or evangelical atheists as I am wont to call them because of their equally self-righteous intellectual positions as their opponents.  While I have not openly written on this debate as an erstwhile theist, indeed theologian, who holds an agnostic position today, I do believe this debate is paralelled by the drugs treatment (psychopharmacological or chemical interventionist) approach versus talk-therapy-only approach.  In other words, what I am arguing here is that there is a balanced middle ground.  Life in general, from my lived everyday experience often presents us with a both/and position rather than an either/or one.  What's missing in the theist-atheist debate is a singular lack of understanding of the psychology of religion; an absence of comprehension of the motivations for belief in ordinary people; a want of an appreciation for the power of myth, of story and of the creative arts.  I shall return to that debate later in these posts when I get the time.  Now I should like to return to the question of medication in mental illness.

A Controversial Issue:

Without a doubt this debate, which I have discussed several times before in this blog, is an extremely controversial one.  However, The recent Irish Times Supplement on Health of the 12th of October 2010 presents what I would call an extremely balanced approach, a middle-ground or a both/and approach.  This is exemplary to my mind.  As a sufferer from endogenous depression of the unipolar variety who, of necessity, has to take medication and who has availed himself of many other therapies including counselling and meditation exercises, I am indeed heartened by this objective approach.  Two professors of psychiatric medicine are allowed to put forward their opposing views: on the one side Sidney Kennedy, current professor of psychiatry at Toronto University (in the medication camp) versus Ivor Browne, emeritus professor of psychiatry at UCD (who is firmly in the anti-drug/talk therapy only camp.)  I am aware that I may be presenting them in a very black and white way here, in the sense that the former may allow for some therapeutic intervention, and the latter for some little chemical or pharmacological intervention.  However, we may conclude from their views expressed in  last week's Health Supplement that while they might not be extremists, they do tend to their respective contrary positions.

Here is a brief excerpt from Professor Kennedy's article/interview :

Prof Kennedy, who was in Ireland recently addressing GPs on advances in treatments for depression, said the debilitating side effects associated with some conventional treatments often prompted sufferers to give up on them. And he said some sufferers were also giving up on antidepressants because it takes some antidepressants so long to have an effect. “They may start to work after three or four weeks, but that is no good to the person who flushes them down the toilet after two weeks because nothing is happening,” he said.

An advocate of a controversial surgery used to treat adults with severe depression who have not responded to other treatments, Prof Kennedy said there had been huge advances in treatments in the past 20-30 years.  Deep brain stimulation (DBS) involves the insertion of wires into part of the brain “to alter the circuits involved in depression” while the patient also has a pacemaker inserted beneath the skin around the collarbone.

Prof Kennedy said trials on about 40,000 depressed patients had been very encouraging, with about 50 per cent showing improvements. DBS has already been used to successfully treat other conditions such as chronic pain and Parkinson’s disease.... His visit to Ireland coincides with the launch here of Valdoxan, an antidepressant he has endorsed for the manufacturers.

Professor Sidney Kennedy
Prof Kennedy said some people were resistant to all medications and other options such as neurostimulation of the brain were a possibility. He said that, while ECT also carried a burden of side effects such as memory loss, it worked for some sufferers. He also said that the key, as far as treatment was concerned, was to seek help as early as possible and to investigate the least invasive methods of treatment first.  (See this link here: Sidney Kennedy )
One can see that Professor Kennedy advocates the importance of early intervention and the use of the least invasive methods first.  Presumably talk therapies like psychotherapy and counselling and cognitive behaviour therapy (CBT) would fit into this non-invasive treatment.   However, one could be cynical with respect to his backing of a certain drug.  One wonders what financial kick-back he is getting for this promotion of their product.

Next, here is a little taste of Professor Ivor Browne's article which proposes the opposite viewpoint, thus:
Professor Emeritus Ivor Browne
Mental illness is seen as a disease caused by either a disturbance in our biochemistry or by genetic influences – but this is a myth.  This view of mental illness arises from a reductionist scientific concept, where the disturbance of the whole person is seen as caused by something wrong with the parts. It’s derived historically from Galileo’s statement that, to make scientific progress, we must concentrate on things we can measure. But this is only half the story and it breaks down when applied to living creatures such as ourselves....Because of the mechanistic attitudes that have accompanied advances in science and technology, the western mind has fallen prey to the illusion that there is a remedy for every ill; we expect to be able to avail of these without any effort or suffering on our part.

When a person comes to a doctor or therapist with symptoms that indicate depression or anxiety, they expect the doctor to do something to relieve them.  Certainly doctors can relieve symptoms, but without the natural healing power of the body and a functioning immune system, medicine and doctors are largely helpless.  In dealing with psychiatric illness, there is no treatment you can apply to a person that will bring about real change in them. The person has to undertake the work himself and this involves pain and suffering.  Many psychiatrists seem to have missed this point entirely. They think that, by giving tranquillisers or ECT and temporarily relieving symptoms, something has been achieved, whereas in fact no real change has taken place and, sooner or later, the person will slip back to where they were.
However, Browne does enter a caveat on drug therapy, so his view is not solely and completely anti-drug as we see in this comment a little later:

The issue here is not the giving of a drug; many of the psychoactive drugs can be the only way of making initial contact with a person who is psychotic, anxious or depressed so that therapy can begin. The question is whether they are given as treatment, or as an aid to working in a relationship with the person. It is not the drug – it is the message that accompanies it that is really damaging.  (See this link here  Ivor Browne )

One can appreciate what both learned professors are saying, but once again I do believe that there is a balanced middle ground between these two advocates of opposing positions on whether to medicate or not.  Taking the Supplement in toto, the view presented is one that is well balanced and tends to no partisan view.  Once again such objectivity is what I would expect from a paper as well known and as unbiased as The Irish Times.

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