November 28, 2005Slaying False GodsWhen I started this site two months ago, I figured about half of what I posted would relate to mental illness and the rest involve politics and culture. I was wrong. That's because there is so much screwed-up crap around mental illness, mental health and the folks who control the system that I could write about nothing but that all the time. There is much good, bad and ugly out there. If anyone thinks we've made tons of progress on mental illnesses in this country, consider: the suicide rate in America is virtually unchanged since 1958, hospitalization rates are higher than they ever have been, and just as many patients are as miserable as they were in 1990 when the pscyhopharmacological revolution hit the mainstream. That was the year Prozac blew up in this country. And suddenly millions of Americans were taking anti-depressants and so on. In the mid-90s, it seemed like every third teen was a diagnosed bipolar. And so on. Has anyone noticed that things don't seem to have gotten a whole hell of a lot better? Has anyone noticed that there doesn't seem to be a lot of honesty about this in the mental health world? Have you ever wondered why this is the case? I'm not an anti-meds guy and I am not going to allege a conspiracy between big pharma and doctors and the government. Still, there is something weird going on when so much money has been spent on meds, therapy, research, etc. and not a damn thing has truly changed. Mental illness is still raging in our culture. Pharma companies are minting money. Where people have insurance, their companies foot most of the bill, but that gets factored right back into the cost of coverage for everyone else. Where people don't have insurance and no Morgan Stanley guy helping them out, then god help them. So what's the deal? Why isn't this working? The prime mover behind diagnosing people, putting them on meds and keeping them on meds forever is that doctors and researchers believe that meds are capable of eliminating any and all symptoms of mental illness--symptom remission as it's known. If med A doesn't work, then you need to switch to med B because there is hope, don't you know? If med B doesn't work, then you need to try med C. And so on. That would be a nice approach if it bore fruit more often. The frustrating thing is that 50 percent or more of patients continue to have symptoms break through meds. And then they end up on a cycle of med switching that goes on for years and still they never find the right med or combination of meds. I know I am stating what's obvious to many patients. The proof, if you want it, is hidden in research studies and academic papers. There, you will often see if asserted that med A remits symptoms of depression in 52 percent of patients, for example, versus 25 percent in placebo. The trouble is that 48 percent of the patients on med A had no remission (and the people who got remission got it for the short-term). They aren't as likely to suddenly get it on some other meds either. But still these same studies are used to determine what docs prescribe in the real world, what the FDA licenses, etc. , but you'll hear very little acknowledgment of this from doctors and researchers and the public health crowd. I am confused about that. But then myths die hard, don't they? The sad fact is that 15 years after Prozac and its brethren were supposed to make millions of Americans whole again, things are just as screwed up as they ever have been. That's not all bad. I think there's a certain power to be gained from the admission that complete symptom remission is a false god and that what we really ought to be doing is getting symptom remission where we can and letting people live where we cannot instead of pounding them to death with meds and wasting billions in the process. Or maybe I am just being a bit too skeptical tonight. But that's what happens to someone who's already made his way to med R--and has yet to see the kind of symptom remission that is the basis of the current psychopharmacological paradigm. Posted by Philip Dawdy at November 28, 2005 12:13 AM
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my grandmother was bipolar. never officially diagnosed but she spent part of her life in and out of hospitals. i know the symptoms, i live them...and she did too. except she lived in a world of "lock them up, watch them drool and throw away the key." what has changed? not much. doctors & pharma companies still continue to throw pills at us and expect us to take them. with little research. and most importantly no long term research. quite scary. but i take them. oh yes, i take them to stay out of trouble. and i deal with the crap side effects. it seems the difference between today and say, 1960, would be patients are talking. we have support groups. families are beginning to understand. but there is still that stigma. the insurance companies, pharma companies, doctors and government need to held accountable. sure, there are some trying, but most sit back and count their money. pondering, should i buy the new lexus or the new saab? i will hopefully live to see a real breakthrough. until that day i will continue to do the things i do to live a productive life. i am fortunate for 3 reasons: Kim and Philip, You guys keep implying that pharma companies and doctors are on the same page, that the two are basically synomonous when it comes to medication. But is that really how it works? Should doctors and pharma companies really be clumped into the same group? As I see it, doctors aren't making any more or less money whether they prescribe meds or not. It's not like they write out a prescription and all of a sudden they can get paid another 90 bucks an hour. With pharma companies it's different: Their profits do actually increase when more meds are dispastched. So, I understand the ganging up on pharma compnies, but doctors...? Why should MDs start getting yelled at when there is no actual benefit for them when it comes to prescribing medication? Where am I off? Posted by: Gwen Davis at November 29, 2005 09:03 PMGwen- I was 13 when I saw my psychiatrist. I'm 32. I can't recall how many doctors I've seen over the years. But I can recall how many doctors sit back, prescribe and do not listen. I'm paying them...good money, a lot of money. I'm not the patient that goes in for meds and leaves 10 mins later. I'm vocal- I'm completely open and honest. I do my research. This past June I found a new doc, she diagnosed me bipolar. This was no surprise. She prescribed Seroquel-she did warn me "this may raise your blood sugar and you should get your sugar tested regularly." I said- well, this won't work. My maternal grandmother was diabetic, died from the disease. My father is diabetic, I don't feel safe going on this med. I also voiced my concern about the drowsiness the drug leads to- I work, on occasion I must wake up at 4am, etc. I can't afford to lose a job over a med. She convinced me. I was desperate- but she was clearly not listening to me. 4 months later I dropped the Seroquel, I don't need to explain why. I've had a therapist fall asleep on me. I've never once felt comfortable and understood. Not one doctor has been sympathetic with my frustrations regarding switching from med A to med B to med E. Not one. And not only do I expect some form of sympathy- I expect an answer. Why? Why is this still a problem. We should be further along here. We should be doing more research. More long-term research. I've seen docs at the top of their field...There is simply no excuse for this. And please, you can only imagine how much money I've spent over the last 2 decades. Even with insurance. And don't get me started on insurance companies. My sister is an insurance agent. I know their dirty secrets. And back to the MDs, I am not a unique case. I'm a patient who wants to be taken seriously. If I had cancer, diabetes or high blood pressure, etc... believe me, they would have answers to my questions. They would be sympathetic. This is why I strongly believe doctors should also be held accountable. Posted by: kim at December 1, 2005 09:22 PMKim, Wow, sounds like you've had it pretty tough. And you're absolutly correct -- doctors should be held accountable. No one has to right to cause others needless suffering. No one. Stay strong! Posted by: Gwen Davis at December 3, 2005 05:31 PM |
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