{"id":20391,"date":"2012-02-28T22:52:11","date_gmt":"2012-02-29T03:52:11","guid":{"rendered":"http:\/\/1boringoldman.com\/?p=20391"},"modified":"2012-02-29T20:55:36","modified_gmt":"2012-03-01T01:55:36","slug":"worthy-of-respect","status":"publish","type":"post","link":"https:\/\/1boringoldman.com\/index.php\/2012\/02\/28\/worthy-of-respect\/","title":{"rendered":"worthy of respect…"},"content":{"rendered":"\n
8:00 AM<\/font><\/strong>  <\/div>\n
    \n
    I was getting ready to leave for the clinic and my wife was playing the phone messages from the day before. One was from one of my oldest friends, a psychiatrist\/analyst, returning a call, "Sorry I missed your call. I’m in my office catching up on my pharmacy calls. I don’t practice medicine anymore, I practice pharmacy! The back number is …<\/em>"<\/div>\n<\/ul>\n
    8:15 AM<\/font><\/strong>  <\/div>\n
      \n
      On the way to the clinic I recalled something this same friend quipped last year, "People don’t want psychotherapy anymore. They just want meds<\/em>"…<\/div>\n<\/ul>\n
      10:00 AM<\/font><\/strong><\/div>\n
        \n
        "My Lexapro isn’t working any more…I was on Lexapro 30mg, Xanax 1 mg four times a day, Seroquel 250mg at bedtime…I’m Bipolar and Anxiety Disorder… When lost my insurance I had to stop the Seroquel and the Xanax…<\/em>"<\/div>\n

        <\/p>\n

        "What happened when you stopped?" I asked… <\/div>\n<\/ul>\n
        I expect you know the answer she gave about withdrawing from those two particular medications at the same time. It wasn’t pretty. The way it actually worked – the insurance she lost was coverage from her ex-husband… which is why the Xanax and Seroquel ran out and the withdrawal symptoms [I think from the Seroquel] kept her home for a few days… which is how she lost her job… which is why she and her two kids moved back in with her parents… which put her back in close proximity with her mother… which is what was wrong in the first place – not Lexapro running out of juice.<\/div>\n

        I doubt my blogging about all this medication madness has done much about the fate of American psychiatry, but it has certainly made me a more informed clinic doctor. I would never have known to ask about Seroquel withdrawal [having never prescribed it or been told about that particular symptom]. As long as I’m on this specific case, the diagnosis of "Bipolar" was made around the time of her divorce when she felt "down." I thought maybe that might have been a mistaking of grief for depression, but that wasn’t actually it – she was glad to get out of the marriage. But when she divorced, she and her kids had moved back in with her parents. You guessed it, home again with mother was probably the reason for the "down" that lead to the Bipolar diagnosis in the first place, and then the medications. As a matter of fact, home with mother may well have had to do with a premature not-so-hot<\/em> marriage in the first place to get away from home.<\/p>\n

        I guess I think of such cases as "circle of life" cases – where a problem leads to a solution, which itself sooner or later becomes the next problem needing a solution, et cetera, et cetera, and go round and round and round the circle again. This lady was not Manic Depressive by any measure. She was actually resourceful and pretty quick-minded. She "got it" as we made these connections. She left with a prescription for Vistaril – an ancient little-bit-of-an-anti-anxiety<\/em> drug. She’s got a new job and I’d bet she’ll be leaving her parent’s house pretty soon. She is also [wouldn’t you know it] having some sexual side effects from the Lexapro and that’s a problem she didn’t know was probably medication related. We agreed to think about tapering it as soon as she gets her living situation squared away – "Now’s not the time," she said with an if-you-met-my-mother-you’d-understand<\/em> look.<\/p>\n

        I also see cases in the clinic where the medications actually help people – where the anti-depressants work, where the undiagnosed childhood ADHD responds to medication. But I see way too many cases like this one where medications actually interfere, or complicate, or do nothing. And I see some where they are a disaster. Today, it was about 50-50 in the morning. In the afternoon, it’s a child-adolescent clinic, and things are more optimistic. I see cases followed by good clinicians. A lot are collaborative diagnosis consults. The rest are people I’ve seen from the start, so if there’s a medication tangle, it was something I did and so far, knock-on-wood<\/em>, there aren’t many. But the comment from my old partner and friend on the answering machine haunted me throughout the day. Actually, it wasn’t the taped message itself ["I don’t practice medicine anymore, I practice pharmacy!<\/em>"], it was the reminder of what she had said before, "People don’t want psychotherapy anymore. They just want meds<\/em>."<\/p>\n

        I think many would hear that in a different way than I did. They might hear something like "See, that psychotherapy stuff doesn’t work … was a waste of time…<\/em>" or maybe  "wasn’t cost effective<\/em>…" That’s not the way I heard it, at least not the way it replayed in my mind today. Patients usually present because they feel "bad," some kind of "bad." And of course they want to feel "good," or at least not "bad" or maybe less "bad." There’s nothing wrong with that. Who wouldn’t? But there are plenty of situations where the bad feeling is a signal that something is very not right, something in life, something in a relationship, something in the mind. Using medications to feel "less bad" – even if it works – can lead to people staying in some really dreadful situations either external or internal. The thing that haunted me today is that I think my friend is right. I think the modern milieu of psychopharmacology and managed care has created a population of patients that expects or feels entitled to "feel better." And medications and faux diagnoses ["Bipolar" in the case above] actually deflect the whole point of emotional life – guidance, emotional guidance.<\/p>\n

        When the system<\/em> is working right, emotions are the gyroscope, the compass, that keeps us on course – including many of the dysphoric ones. There are plenty of diseases that throw the system<\/em> out of whack – the traditional psychiatric disorders – things like Melancholia and Schizophrenia. There are acquired problems, things like personality disorders, PTSD, etc. that themselves disrupt the system<\/em> in global ways. But, in my experience, the majority of people who wandered into my office are people where the system<\/em> isn’t the problem. The signals from the system<\/em> are right, they’re just not being heard, or are misunderstood, or are ignored. I’ve always seen my job as figuring out about that. Is it the message from the system that’s haywire or is the problem in the receiver?<\/p>\n

        I think that my partner was correct. The focus on medications for bad feelings that’s in the clinical trials, the DSM-whichever, the ads on television, the way insurance has directed mental health care, the articles in our journals has had a culturally damaging effect – not so much the "feel good" generation eg drug culture [though that may be part of this], but more the automatic focus on how-one-feels<\/em> as the central problem. Patients these days seem more in the "what do you have to make me feel better?<\/em>" mode than the "I feel bad can you help me?<\/em>" mode. I don’t like thinking that because it feels a bit like blaming the victim, but it’s what I feel none the less.<\/p>\n

        So back to that 10:00 lady I started with. The case has been changed around some to disguise her identity, but the essence of things is accurate. The reason she stood out in my mind is because of how she wasn’t<\/em>. She came in talking like a disease<\/em> that needed a tune up<\/em>. But she was easily engaged in looking at things differently and quickly joined in the process of parsing out the story [the "I feel bad can you help me?<\/em>" mode]. The pieces about her relationship with her mother seemed like little light bulbs. I don’t think she had really ever connected jumping into a marriage to get free, the "down" when she moved back in after her divorce, and the recent "lexapro isn’t working" down having moved back home as all related with each other as part of her narrative. I don’t know what the problems are between she and her mom, only that they are significant – and I’d bet money she’ll have something to say about that later. <\/p>\n

        We talk a lot in these blogs about the problems psychoactive medications can cause, and rarely discuss when they can help [which really is "sometimes"]. What we don’t talk about is how this hyper-chemical<\/em> viewpoint might be interfering with how people see the most basic "compass-like" functions of emotional life. In this case, "I’m Bipolar and Anxiety Disorder<\/em>" would never ever help her. There’s a lot more mileage in "Whenever I’m with my mother, I get down<\/em>" followed by "I wonder what that<\/em>‘s<\/em> about?<\/em>" The larger point, obviously, is that the pathologizing of negative emotions seems to me to have had a negative effect culture-wide, independent of any down-side of medications themselves. We didn’t spend all the eons evolving or getting created to have a system as complex as the capacity to feel "bad" only to see it as something to shut down. It has a central and important function – worthy of respect…<\/div>\n
        When you’re lost at sea in a submarine, you don’t turn off the sonar… <\/em><\/sup><\/div>\n","protected":false},"excerpt":{"rendered":"

        8:00 AM  I was getting ready to leave for the clinic and my wife was playing the phone messages from the day before. One was from one of my oldest friends, a psychiatrist\/analyst, returning a call, "Sorry I missed your call. I’m in my office catching up on my pharmacy calls. I don’t practice medicine […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_bbp_topic_count":0,"_bbp_reply_count":0,"_bbp_total_topic_count":0,"_bbp_total_reply_count":0,"_bbp_voice_count":0,"_bbp_anonymous_reply_count":0,"_bbp_forum_subforum_count":0,"footnotes":""},"categories":[2],"tags":[],"class_list":["post-20391","post","type-post","status-publish","format-standard","hentry","category-politics"],"_links":{"self":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/20391","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/comments?post=20391"}],"version-history":[{"count":13,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/20391\/revisions"}],"predecessor-version":[{"id":20457,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/posts\/20391\/revisions\/20457"}],"wp:attachment":[{"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/media?parent=20391"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/categories?post=20391"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/1boringoldman.com\/index.php\/wp-json\/wp\/v2\/tags?post=20391"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}