The Big Comeuppance. Remember?

 I’ve been working on some of the current issues that define our mental health.Somebody wondered if psychiatrists should brace themselves for a round of lawsuits involving dangerous pharmacology. 

Here’s what I had to say about that…
hopefully they’ll publish the comment.  I’ll be watching.  If anyone ever uses a damp Thanksgiving as an analogy for disordered states, let me know.  



I’m clearly the Expert. 


“I would like to think that most conscientious practitioners DO try to keep their patients well-informed, not in fear of liability but to provide appropriate care. I am not sure that doctors ought to be held wholly responsible in any potential liability suit.

Many doctors are under tremendous pressure to prescribe dangerous drugs and many, if asked, could not tell you the specific ways that, for example, Abilify works on dopamine and serotonin receptors or what physiological processes create the conditions in which side effects manifest. Nor could they tell you what additional factors may impact the efficacy/risk of the drug.

In many cases, doctors have not been supported in keeping themselves well-informed and are simply handed a box of free samples that, as in the setting I work within, are provided to consumers who are often reassured by the colorful packaging and the possibility of relief. Often this transaction occurs within a 1/2 hour “med check” – a ritual that leaves little time to discuss the details of the powerful medication that is being prescribed. I do not believe that most doctors intend, in any way, to provide their patients with medication that can be harmful.

People do experience significant states of psychiatric distress and it is a shame that our systems of care do not allow many resources for non-pharmacological intervention.

I believe that pharmaceutical companies should be held accountable, should be held responsible, for promoting products they know to be harmful and for lobbying legislation/policy and treament protocol that support their profit interest at all costs. I actually think that doctors, at this point, have fair reason to sue pharmaceutical corporations, and certainly many patients do.

It is sad that a psychiatrist could, if faced with a patient experiencing significant symptoms that could affect safety, actually be in big trouble themselves if they did not offer therapeutic intervention and that, in many cases, the only intervention available is pharmacological. That’s not a nice position to be in.

I do not understand why more psychiatrists do not widely support crisis alternatives such as Peer Respite and preventative modalities such as WRAP.

This brings us to Jim Gottstein’s question, “Are psychiatrists fooled or complicit?” It’s a good question. I think that there needs to be an additional option. “Are psychiatrists themselves coerced?” I think that, in the culture and practice of modern psychopharmacological psychiatry, they are.

As an aside, I do not think that “complex circuitry disorders” are remotely difficult to explain or make sense of. Consider states of distress and disorientation as a cause-and-effect process, involving neurological conditions (for example, stress hormones and serotonin levels) that are associated with particular modes of conscious experience, with distinct cognitive and emotional states that manifest as disordered.

I told my students the other day, “They call it a disorder because, in very real ways, things do become disordered. If you experience a traumatic event, your brain and body are affected by a flood of stress hormones. Over time, exposure to these chemicals can actually affect the structure of your brain. As an example, consider the hippocampic regions of the brain in children who grow up with chronic abuse.

What happens if someone pours a bucket of water on the Thanksgiving meal. Yeah, it gets wets, things spill and drip. The whole thing is a mess. It feels like a disaster.”

I draw a lot of arrows on the classroom board, to show how particular stimuli trigger specific neurological events (such as a release of cortisol when one becomes angry) and how, because of the way the brain processes and organizes information, there can be corresponding events within the emotional sectors of our brains and these then are associated/interpreted cognitively, often in the form of distressing and pervasive thoughts that are themselves traumatizing and serve to reinforce the disordered state.

I think that makes much more sense than “Your chemicals are out of balance.” It seems to offer people much hope that there is a rhyme and there is a reason, and – using basic principles of neuroplasticity – there is the possibility of healing distressed frameworks and learning new ways of experiencing the world.

Thank you for the opportunity to articulate this. As a Peer, I find these approaches to be live-saving. They certainly saved my life, and did so in ways far more profound than simply staying alive. The students I referred to above are adults in recovery from mental health and addiction challenges. I work in a semi-rural community in western North Carolina and the students at the Recovery Education Center, by and large, have minimal schooling and many of them carry PTSD diagnoses in addition to their Axis 1 diagnoses. They understand when I speak about cause+effect=experience and their eyes light up when they are validated in the fact that, when bad things happen to us, we get hurt in some very fundamental ways that affect the way we process our experience of the world.

As for the Thanksgiving meal and the bucket of water…you clean it up, bit by bit. You learn to appreciate the way the water-warped wood looks like a wave. You learn to tell the story in a way that makes you smile and helps you to appreciate all your peaceful meals.

Or you just throw a heavy blanket over it so you can’t see the mess and you try to keep dining as if everything is all taken care of. Clearly, given the lumps and stains and drips, it is not all taken care of.

If poor people in economically-depressed mountain towns can understand how we come to experience things in the way we do, why can’t people who went to medical school?

 
 
Viva the Big ComeUppance.
It’s already here.

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