Since I have written that psychiatric disorders are not usefully called ‘illnesses’ (About Hope), and that there are useful therapeutic approaches (Solution-Focussed therapy; Jay Haley’s family approach to schizophrenia), I favour clients and families being offered choices such as these. These are largely precluded when a simplistic description such as ‘illness’ is used to explain complex life problems.
Some people do benefit from medication and it can be offered. However there is no need to perpetuate ideas of ‘illness’ as a rationale for using medication – if it has been found to be useful, it can be offered; if people then find it to be useful they will use it. If it’s not adequate they will consider alternatives.
Presently in Western societies many clients are largely told, “This is the treatment, and you must take it,” (irrespective that symptoms may remain after trialling it for months already.) “And if you don’t want to continue we will get legal orders to make you, because it is an ‘illness’ and you need treatment.”
Mainly I favour, if it’s not working, let’s look at alternatives.
There will always be some clients the community wants to control because they are dangerous. Psychiatry tries to delineate between those it deems to be bad, as opposed to ‘mad.’ Those deemed bad are left to the justice system. Those deemed mad and need controlling are usually called ‘ill’ and medication is forced onto them. For those who are dangerous, if the justice system is not going to control them, I favour the use of medication (or something) to control them. But there is no necessity to mislead people by saying they are ‘ill.’ Wouldn’t it be better to be honest and declare we are controlling you because of the way you have been behaving? They can then choose to change or behave the same; this avoids arguments and denials about being ‘ill.’
Troubles Caused Through Illicit Drugs
Many individuals, who repeatedly abuse drugs and behave in mad/strange/bizarre ways, are often hospitalised if they have not behaved criminally. There is no need to label these people as ‘ill.’ They are behaving in ways that are annoying to the community, utilising time of the police and other services that cost money.
They are treated as ill and rescued from many financial consequences (welfare services supply more housing, clothing, and food etc.) There often is no hardship that might motivate them to review their choices and change their life. Families have often been told these individuals have an ‘illness’ which invites them to continue providing financial and other material support, which perpetuates irresponsible choices.
When questioned some families respond with, “They are ill; they can’t do any better.” The concept of ‘illness’ is yet again an obstacle to people considering more effective alternatives – would these family members excuse irresponsible behaviour of young children, or rather would they understand people need limits and consequences to learn? The same will help some of the people who repeatedly abuse drugs.
Informed Decisions and Choice
How well informed are clients at present? What choices of treatment are they offered? Are they likely to be discharged from the service if they do not want medication treatments, rather than be offered help in other ways? Are clients’ problems explained primarily in biological terms?
Should clients be told they have a biochemical imbalance in their brain when there’s no evidence for what amounts to a metaphor? [See my article, “About Hope” and its section on Linguistics.]
Is family therapy available at your local service?
Informed choice is also compromised when multinational companies largely control the testing of drugs and reporting of findings. (Elliott S. Valenstein – “Blaming the Body: The Truth About Drugs and Mental Health.” See also, the last two chapters of “Mad in America: Bad Science, Bad Medicine, and the Enduring Maltreatment of the Mentally Ill,” by Robert Whitaker. See below for full references.) Vested interests can be tempted to bias research design and reporting. The two authors above (especially Valenstein Ch. 6) detail examples which suggest this is common in an industry where bringing a new drug to the market costs hundreds of millions of dollars. Valenstein (page 189) also notes that Clinical Trials conducted by pharmaceutical companies result in successful findings much more than when independent government funded bodies conduct trials.
There is much written about the influence that these companies have over prescribing patterns of doctors; much can be found at the following websites:
Increasingly one might wonder whether the medications we are prescribed, result from the appraisal of scientific studies or the marketing tactics of the drug companies.
An alternative that would restore impartiality and confidence is that companies could develop new drugs to the point of clinical trials; then hand the experimental drug over to truly independent bodies to evaluate and report. Claims of effectiveness would then be powerful. Are we likely to see pharmaceutical companies eagerly accept such a proposal? Or will they fight to maintain independent control as much as possible?
In some clinical trials of no difference has been detected between the medication and the placebos! Dr. Colin A. Ross (“Pseudo Science in Biological Psychiatry,” p86, See full reference below) quotes from Kaplan’s “Comprehensive Textbook of Psychiatry” Vol 3 (Kaplan, Freedman, & Sadock, 1980) that “in a meta-analysis [a large, comprehensive review of the research literature] of double-blind chlorpromazine studies in schizophrenia, the drug was found to be superior to placebo in 55 trials, but equal to placebo in 11 (p.2258) This meant that in 17% of trials, chlorpromazine is no better than placebo in treatment of schizophrenia.” [Does it make you wonder whether the 17% were conducted by government/independent researchers, and the rest were conducted by drug companies?]
Chlorpromazine was a drug commonly used for schizophrenia for decades. Does this make you wonder how good psychiatric drugs really are? When you read in this field, you wonder whether there is anything different about the drugs used in psychiatry today.
Consumers and Families
This information is rarely shared with consumers/families. It would obviously make it difficult to convince them to accept the medications, since many have significant and/or serious side-effects. Yet to be equal participants in decisions about their health, shouldn’t consumers and families be informed? Not doing so perpetuates a parental approach, and supports the simplistic view that people’s complex problems are personal ‘illnesses.’
Sharing the available knowledge will lead to greater debate and participation by consumers, and has the potential to foster greater collaboration as we search for answers together.
1. Elliot S. Valenstein PhD, “Blaming the Brain: The Truth about Drugs and Mental Health” (The Free Press, NY. 1998)
2. Colin A. Ross and Alvin Pam, “Pseudo-Science in Biological Psychiatry: Blaming the Body.” (John Wiley & Sons Inc, NY. 1995)
3. Robert Whitaker, “Mad in America: Bad Science, Bad Medicine, and the Enduring Mistreatment of the Mentally Ill.” (Cambridge, MA. Perseus Publications, 2002.)