10+ Year Member
15+ Year Member
- Mar 16, 2008
- Reaction score
Data on this long-term prognosis? And are you acknowledging the efficacy of meds then?
I guess my question is this-- can you show me the data that the long-term prognosis is better for someone receiving other psychiatric interventions without medications, compared to those that receive the medications?
There were, I think, four wide NIMH-sponsored studies in the seventies that specifically addressed this issue. I can give you the exact names when I get home next week. They all showed that medications help end a psychotic episode quicker, but in the long run the patients who never took meds tended to be much less prone to repeated hospitalizations; in fact, something like two-thirds of them were not hospitalized again after I think 3 years, while about two-thirds of the treated patients were back to the hospital within a year. Moreover, even a relatively short course of a drug was enough to produce the effect. These are very interesting studies. Nothing like this is being done today, for whatever reasons.
So yes, of course I acknowledge the efficacy of the medications. It would be stupid not to. But I maintain two important points: first, you pay a price for their help, and second, they don't even come close to addressing the cause, even the official one. The levels of neurotransmitters that the drugs act upon in a treated brain differ from the normal by an order of tens. Some speculate that the medications act as a terrible stressor for the brain, which in response puts forth its best effort to survive the attack. So yes, they work in many cases, but because we know so little about them, they must be used as a last resort, that's all. And choosing to use them when other options are available is no less than a moral choice that everyone must make for themselves.
I agree. Here is a side thought about suicide. Should we continue exchanging quotes? Camus said that the most important question in life is whether or not to commit suicide. Why is it that suddenly everyone thinking about suicide is 'clearly out of his mind'? I mean, this is an age-old question. One requires serious counseling in this situation, by people who really understand the issue deeply, and instead the question is pushed away, and tends to be simplified and ridiculed.Unfortunately you cannot force someone to change. You can only offer them the means to do it. If someone is absolutely determined to kill themselves, attempted and failed but still determined, then I can hospitalize them against their will for 17 days, even get a court-order forcing them to take meds while in the hospital, get counseling for their family, have family meetings, social work interventions, and all the psychotherapy offered to them, but if they don't choose to take advantage of those services and choose to kill themselves once they leave the hospital, then I cannot change that. And that happens.
You see, essentially, my problem with biological psychiatry is this: when you try to explain every human soul movement by means of chemistry, you do nothing but engage in good old denial. Yes, in some cases the problem is really organic; if you have syphilis of the CNS, you might safely disregard the psychological side of the problem. But by persuading everyone that their misery is chemical you effectively turn a blind eye to the real causes of distress. In many cases a problem is not only purely psychological in nature, but can be helped or even cured by psychological means, even if the chemical changes are involved. Not allowing this to happen, and concentrating on altering the brain chemistry from without, is, I think, dishonest. Sorry, I got wandered away a bit.
I didn't mean you did. I used 'you' in general sense. And I hope very much not to be dismissed; at least, we have a common enemy - reductionism.I don't take things in isolation. <...>
Usually we're a little more detailed than that. If you continue to take an extremist oppositional approach to the use of medication, then you'll be dismissed the same way I dismiss biologic reductionists-- short-sighted and inflexible.
I don't want to sound simplistic, really. Yes, I dislike medications, but I agree to use them in a last-resort scenario. And the medications, however hot the topic is, are only a part of the problem. But again, I don't want to judge anyone in particular or the nation as a whole. Perhaps I don't understand a lot of things about America. I am just trying to figure out whether I may be able to practise psychiatry here, or will I become depressed very soon I appreciate your help in verbalizing these complicated issues.
Yes, but only if you are really talking about action. Because taking meds is not an action; it is passivity. It is allowing one's self to be acted upon. Other than that I of course agree with you. If you can use medications to help you motivate people to take some kind of real action, you have my blessing.And Eschylus said "Exiles feed on hope." It's what keeps them going and trying new things despite overwhelming adversity. Hope does not imply passivity, but rather a motivation for actions in general. If I told you to be hopeful that driving down the street would make you meet your soulmate, that doesn't mean you're going to sit and not drive down the street.
Yes *sigh*. And a discussion on why even your personality is not you, and what follows, is hardly possible on a forum like this at all...Now you make a good point that many pt.'s think meds are their only solution, and that starts to touch on a whole other aspect of western culture and psychiatry, and that none of us pretend meds will really help -- personality. Personality, from types to dysfunction, and our systemic inability to properly treat it or choose not to treat it, is a discussion for another day.