Wednesday, August 26, 2009

Antipsychotics et al

A friend of mine posted this to Facebook today:

Her comment was “I just cried”. My feeling was similar, but it also made me think about the range of drugs that are used for taming the psyche—everything from Ritalin to Prozac, to higher-powered anti-psychotic drugs. Balancing out the need for such drugs versus their effects is hardly an easy task to say the least.

From what I can tell, genuine mental illness involves an actual chemical imbalance or injury within the brain. But what is imbalanced? The more I read Anthony Peake, the more I think about how those abnormalities might actually be door-openers. Many “mentally ill” patients are perceiving a truer reality than the rest of us. When I was a public service librarian for a short time, we had several schizophrenics who visited us daily, and not all had taken their medication. They would see things that I didn’t see, and argue with people whom I couldn’t see. I usually went along with their perception of things. After all, I told my co-workers, how do I know that they’re not really there?

The thing that makes mental illness an illness is the inability of sufferers to negotiate what we consider “normal”. They don’t follow normal social rules, they see things that we call hallucinations, sometimes they are even violent and disruptive to those around them in a significant way. Psychiatry’s means of handling this is to provide drugs that will dim those perceptions. One of the things Peake mentions in his book is the fact that the brain (interestingly, like organized religion,) is meant to limit our perception of reality, as we can’t “take it all in”. The schizophrenic is taking it all in, and can’t process it. Anti-psychotic drugs are meant to limit these perceptions, to bring the sufferer around to the narrower view of the world that all of us have.

In cases where the person is dangerously out of step and harms others, it is easy to see why this is the preferred solution. But what about other less obvious cases? I mentioned Sylvia Plath yesterday. From what I’ve read about her life and what others have said about her, I can’t help but see someone who fits the classical definition of bipolar. (I’m not a psychiatrist, so you should take that with a grain of salt, but I still think the theory has merit). But let’s assume that Sylvia went to a psychiatrist and was diagnosed as such, and medicated as such. Would she have produced the great poetry, exhibited the great genius she had throughout her life? Given the effects of drugs like lithium, I’m not sure the answer would be “yes”.
I imagine psychotics are like alcoholics—there are functioning and non-functioning types. One question I have is whether or not functioning psychotics who are not dangerous need to be on such drugs at all. I also question putting children on drugs meant to alter their brain chemistry. What is the cost of having a child who is totally “under control”? What have you given up to get there?

I’m not suggesting that certain imbalances don’t need to be treated. I’m just not sure that giving someone what amounts to a chemical lobotomy is such a great idea. Can drugs be developed that calm the more dangerous behaviors without totally cutting off all the good stuff that comes with that openness? I don’t know enough about brain chemistry to intelligently discuss alternatives. But I do wonder if it’s been discussed in the psychiatric community, or if they even see a problem with it.

One thing I do have a problem with is the political and insurance issues that often surround what passes for “mental illness”. If you take the case of children—a child who is unruly or distracted in school may be considered to have ADD, or borderline ADD. A doctor will recommend a drug like Ritalin. I think drugs like Ritalin are often over-prescribed—not all children need that kind of medication, just as a lot of us don’t need the high-powered antibiotics prescribed for minor infections. Why prescribe Cipro when Amoxicillin will do the job? Treating depression is another such area—far more people are on drugs like Prozac and Xanax than is probably necessary.

The problem here is an insurance and malpractice problem. If someone goes to a psychologist or psychiatrist with depression symptoms, they will immediately prescribe an anti-depressant, to “cover” themselves in case the person becomes suicidal. If someone in their care becomes suicidal and they didn’t prescribe anything, they leave themselves open to being sued. As if giving a pill is going to solve your depression problems. But that’s how society thinks, and that’s how families of victims think. They need someone to blame when things go awry with their loved ones. There is a perception that we are not getting our money’s worth if we don’t walk away with a piece of paper that gives us some kind of “cure”.

So, it’s hard to blame the doctors for doing it, but I wish that as a society we would place more emphasis on teaching people personal responsibility and life skills rather than just medicating the shit out of them. Borderline Personality Disorder is a good example of such a problem. Borderline patients basically lack an emotional “skin”—they have a hard time negotiating suffering of any kind. The most successful therapy for Borderline patients has proven to be something called “dialectical behavior therapy”. Time Magazine had a good article on this that you can see here. Instead of giving the person drugs, they are basically taught HOW to grow the emotional skin they are lacking. The cure rate (meaning the person is no longer diagnosed as Borderline at all) using this method is 100%. So why isn’t it used more often? “It takes too long.” We all want results right now, don’t want to work for anything. And I’m sure the cost of long-term therapy is high. But it’s another example of preferring a cheap quick-fix that doesn’t really solve the problem over, well, really SOLVING the problem.

As I said earlier, I’m not a doctor, and I don’t live with anyone who has any of these disorders, so I’m sure there are many factors involved in diagnosis and treatment. But knowing the way our society rolls, I still think it’s something to think about.

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