It is easy to be misled into thinking that medications work, especially as it is in the interests of drug companies to make it seem so. Hence clinical trials are the attempt to use science to determine if they work. Drawing conclusions on the basis of personal experiences with individual clients is risky. Below are some considerations.
Possible Errors in Thinking
1. Some staff are convinced antipsychotic medication works for the following reason. Following use of these medications staff see a reduction in symptoms; the presumption is the medication caused it – possibly so. Or there can be a different explanation.
Some family therapists posit there are times the person being labelled as sick stabilises a fragile family or marital situation (as described in my article, “There’s an Underlying Biological Illness,” http://www.tomblackford.com.au/2011/04/24/theres-an-underlying-biological-illness/ ) By labelling a symptomatic individual as ‘ill’ and medicating him/her, the focus is changed; the original crisis (often hidden) in the family is postponed while they attend to a more immediate concern. This may stabilise the situation for months, but if the patient returns to normal behaviour the original crisis returns. Where they are still unable to manage it, the patient may relapse so the family once again focuses on him/her. If the hidden crisis is not addressed successfully, the person labelled as a patient may become locked into the role of a sick person.
The above explanation is only a theory, just as medication improving symptoms is only a theory. I point out there are different theories, so one will recognise that occasional successes with psychiatric medications do not prove there is a biological illness.
2. Doctors might believe a medication is working because the patient may report a reduction in a symptom. That sounds good, especially if the client is happy. However, if they are not living their life more functionally is it necessarily a success? For example, if they are now sleeping and they don’t feel so dreadful, but they have headaches, dizziness or fatigue, to the point they still stay at home, isolated and bored, do we claim progress in treating the depression?
I think it is just human that we cannot pay attention to many difficulties at the same time. If you were deeply troubled by some relationship difficulty, but then broke your leg and you suddenly could not earn money, most people would be consumed by the pain and financial worry. Most likely the original trouble would take a lower priority. With patients, they can sometimes exchange symptoms for side-effects, which is not necessarily progress.
Yet I hear doctors tell patients they are getting better, and just need to find a way to manage the side-effect; or perhaps to change to another medication with tolerable side-effects. Sometimes after 12 months of treatment they are still trying to find a suitable medication. They eventually may settle for the best compromise, but are they living life well? I wonder would they be just as good with no medication, or learning ‘mindfulness’, or exercising more?
3. I hear psychiatrists say, “S/he has been depressed for years; you can’t expect the medication will work immediately.” Or, “her delusions are less intense,” implying improvement (but still delusional, and perhaps only given up talking about them to people who don’t believe them.) Or, “we know it works; s/he just cannot tolerate a high enough dose.” It seems unacceptable to conclude it doesn’t work, so medications once started are rarely stopped. Usually they are added to, premised on the belief of proven efficacy.
Perhaps a Different Standard is Required
Contrast the above with Jay Haley’s personal standard. (He was a noted family therapist.) Early in his career he dismissed his own talking therapy as proven if he took many months to solve a person’s depression. He noted that the person might have changed work, a relationship, or other important circumstances. Those could equally be the cause of improvement. Hence he focused on developing brief therapy methods. If these interventions caused lasting change in a short number of weeks then he felt successful. Essays 3 & 4 show there are tools for serious problems that might well be tried before medications.
Years on Medication Can Be a Problem
Some people on medication can gain the desired benefit, which is great. However when they don’t, should the medication be stopped? By continually searching for a medication solution, another problem can emerge.
I know a client who is receiving 3 antipsychotics, one by injection. He is on a ‘mood-stabiliser’ morning and night; he is also on an antidepressant, and some non-psychiatric medications. He willingly accepts the medications and even seeks higher doses, hoping for improvement with his symptoms.
The last 2 or 3 years have not given a good result. I do not know in detail the level of functioning for the decades before. Perhaps there were better periods; if so, they could well have been from life circumstances as much as medication.
While he is diagnosed and the dominant paradigm is that he needs medication, carers in his life call for medication reviews to solve his symptoms and behaviour. His history of trauma and past behaviour tell us he needs connection with people, acceptance, a way to contribute meaningfully to others, and opportunities for fun. However, his carers did not see they had a responsibility to address his needs. They did the minimum by involving the mental health service.
The mental health service uses much of its resources in listing symptoms, deciding on medications, and reviewing changes. This uses resources that could be used to advocate and help meet the human needs of its clients. Since carers and families are mostly convinced of the biological theory, they frequently want medication tried – this delays other necessary interventions, sometimes permanently.
Maximising Efforts of Clients
Some psychological approaches rely on reframing people’s problems as ‘not illness,’ so they realise they have capacity to effect change in their lives. If mental health services communicate to people they have an illness, doesn’t that undermine their belief that they can find solutions other than with medication? Is it fair to doubt them?
Many times I hear statements made to clients with certainty about medication being valuable, useful, proven. It seems the professionals are offering their beliefs, which is contradicted by the information I read. While medication may be useful to some clients and worthy of trying, are clients being given accurate information? What do we want clients to believe about their innate capacity to find solutions? Do we want to instil reliance on others, or on themselves? What is the best way to proceed?
(Go to essay 9.)