The mental health care system is a unique culture. Psychiatry itself is unlike any other medical specialty. The psychiatric community is an enclosed system. This means that it is a world within a world. The doctors, therapists, patients, and support workers play roles. It's a reciprocal environment. Each player in the system allows the other person the opportunity to act out his or her role. For example, the psychiatrist gives you a diagnosis that has no basis (Yes this does happen from time to time). Having complete faith in the powers of the behavioral health system, you unhesitatingly accept this diagnosis as the gospel truth. In time, you begin to notice certain behaviors and thoughts that you believe may be a sign of your supposed illness. You return to your doctor and report these symptoms. The psychiatrist agrees with your observations and writes them down in your medical record. He also inserts his authoritative opinions to support his diagnosis. Therefore, both parties in the relationship are mutually validated in their roles.
When one has been playing the patient role for so long, a person begins to identify himself or herself as a "psych patient." That's who you are. This is the term that defines your very existence. You belong to the mental health care system. Soon enough you find that every activity you engage yourself in is related to your disorder and the medication your doctor prescribed to suppress it. It's a sad commentary indeed. It's sadder still for the person who needlessly struggles against an undefinable defect in his or her character as if the diagnosis were the irrefutable truth. I acknowledge the fact that the unsettling scenario I am painting here is not true for every psychiatric patient.
Remember this. Once you get into the mental health system your chances of getting out are slim. There are a number of reasons for this. Primarily because the psychiatrist or psychologist has you convinced that you have a serious medical problem, which you can't handle yourself. We all know that's ridiculous. Many people manage their depression and anxiety quite well without the use of psychiatric medications. If Ativan calms your nerves and helps you function normally, then that's great. On the other hand, I have seen plenty of people become addicted to sedatives. These drugs are unsafe. I wouldn't put your faith in the safety of the anti-depressants either. The pharmaceutical giants are quick to point that out as a result of the numerous class action lawsuits that have been filed against them.
Some blame can be placed on the pharmaceutical companies for this unnatural drug dependence. I surfed NAMI's website (National Alliance for Mental Illness) and noticed "In Our Own Voice," a public education program, is funded by a grant from Eli Lily. This is the pharmaceutical company that manufactures psychiatric drugs like Prozac, Zyprexa, and Cymbalta. I gather (without too much mental effort) that Eli Lily's generosity is a publicity campaign intended to make them look like one of the good guys in the mental field, and as a result, boost sales.
As I surfed the Internet, I found that NAMI has been receiving their fair share of criticism for their questionable association with pharmaceutical companies. I will not say NAMI is immoral or unethical. That would be too easy. If Ely Lily offered me thousands of dollars, I would have to seriously consider taking it. Sometimes the decision to cross the line depends on one's real life needs. Other times it just has to do with making a buck. There is no denying that this kind of corporate misconduct adversely affects the mental health care system and exacerbates the suffering of its consumers. Again, I understand that some people require the assistance of the pharmaceutical companies and the psychiatric community. The screening process for prescribing these medications is a big part of the problem. That's because there is no adequate system in place for dispensing these potentially dangerous drugs.
I have a particular issue with atypical anti-psychotic medications such as Zyprexa, Seroquel, Abilify, and Risperdal. After taking Risperdal for over fifteen years for bipolar manic-psychosis, I was told by my prescriber that I no longer need it. My psychiatrist told me that she "believes my patients should experience their emotions. I was thinking "You mean human beings should experience emotion? What a marvelous idea!" In a follow-up appointment, I asked her about the memories and emotions I was experiencing with such great intensity. She told me that Risperdal has a blunting effect on emotion. It actually suppresses one's feelings. I wish my last four or five treaters had mentioned this terrible effect. Since emotions do not go away, but rather pile up, I recommend that people process their emotions while they occur rather than putting aside for a later time. Anti-psychotic medications should be used as a treatment of last resort, and only in cases where a patient is not responding to milder therapeutic treatments.
I recently learned that Jansen, the pharmaceutical company which manufactures Risperdal was sued by a number of states for their deceptive marketing practices. Apparently Jansen's sales representatives were encouraging child psychiatrists to use Risperdal on "unmanageable" children. There is a mental health condition the psychiatric community calls "oppositional defiant disorder." Here are the criteria for diagnosing this so-called mental illness (This was taken from Wikipedia):
Some signs and symptoms that must be perpetuated for longer than 6 months and must be considered beyond normal child behavior to fit the diagnosis are:
"The child must exhibit 4 out of the 8 signs and symptoms listed below in order to meet the DSM-IV-TR diagnostic threshold for oppositional defiant disorder
- Actively refuses to comply with majority's requests or consensus-supported rules
- Performs actions deliberately to annoy others
- Angry and resentful of others
- Argues often
- Blames others for his or her own mistakes
- Often loses temper
- Spiteful or seeks revenge
- Touchy or easily annoyed
Generally, these patterns of behavior will lead to problems at school and other social venues."
Essentially, any child in America could be diagnosed with oppositional defiant disorder as defined in the Diagnostic Statistical Manual. For this reason, any child could potentially be prescribed anti-psychotic medication.
Interestingly, the Jansen sales reps also walked into nursing homes encouraging the doctors to prescribe Risperdal to their dementia patients. It wasn't until elderly nursing home residents started dying from Neuroleptic Malignant Syndrome that people started complaining about this drug. The lawsuits filed against Jansen resulted in a billion dollar settlement. This money went to state coffers to recover the health care costs involved in treating the victims. At least that is their claim. This landmark settlement is one the largest in pharmaceutical history.
When Zyprexa first entered the prescription drug market, I was prescribed to me for anxiety. I remember at that time I was taking classes at my local hospital for frustration with the mental health care system (I realize that now). I met a person who was serving time in an inpatient unit for bipolar disorder. I knew him from years before. This man was anxiously pacing on the floor. His restlessness was making me nervous. I noticed he was popping a pill every fifteen minutes. I asked him what he was taking. He said Zyprexa. I was troubled by this, so I expressed my concern to a nurse. She said, "He has a PRN for it, but even that has its limitations. For those of you who are not familiar with medical terminology, PRN means "as needed." Thinking back on this, I am wondering if this man is still alive.
I use to hear psychiatric patients complain about how their doctors experimented on them. I thought this statement was a little far-fetched (especially coming from a psych patient). I realize now that this is exactly what they were doing to me. I believe the term the medical community gives to this dangerous experimenting is "off label use." I do not know if off label drug use is unique to psychiatry or if it is common practice in all medical specialties. I am under the impression that medications proposed to treat a certain condition, must undergo medical trials before entering the prescription drug market. I have found myself in the emergency room more than once because of this off label use practice.
Society itself contributes to this dysfunctional culture. The general attitude of the public is "As long as they are not bothering us you can do what you want with them." This gives the mental health providers even more power to do as they please. And so the psychiatric patient is stripped of his or her rights. As I see it, a psychiatric patient is a human being without respect or dignity. You can call my words dramatic if you like.
It may seem as if I am playing the blame game and taking on the victim role. Allow me to clarify the role of the patient in the mental health care system (those like myself). I will be the first to admit that the informed psychiatric patient is the one who is primarily responsible for his or her unfortunate situation. We have to accept our role in the system. No one can twist your arm behind your back, and say, "Go see a therapist about your anxiety." At least that's true in most cases. When you reflect on why you did it, you will say, "It seemed like a good idea at the time."
The worst thing a mentally ill person could ever do is reveal his or her expertly diagnosed psychiatric illness to others. As soon as you do, your friends will treat you differently. An automatic flash goes off in the person's brain, "Oh God. Here we go. His illness is acting up." This attitude is especially noticeable in the face of a mental health professional, your family members, and closest friends. It's a universal reaction. From the moment, you divulge your dark secret; everything you do will be blamed on your illness. The ways in which you express yourself as a normal human being will be measured against your supposed disorder. If you are frustrated about something, the people in your life will conclude, "His meds aren't working." When people think you cannot hear them, they will gossip amongst themselves, "Oh he's a psych patient. That's why he looks agitated. That's part of his illness." This attitude is quite common. It comes from a lack of understanding. How could a person know what a mentally ill person is experiencing, unless he or she has personally been a patient of the psychiatric system?
If you should attempt to verbalize your rights as a human being, the mental health provider will proceed to have you committed to a psychiatric hospital against your will. In Massachusetts, they have the permission of the commonwealth to hold a person indefinitely. A patient can only be released from a facility when a clinician decides the person has come to his or her senses. Mental health professionals can essentially do whatever they want with you because no one is going to speak out against their abusive practices. Consumers of the Massachusetts psychiatric system must retain a specially trained lawyer to represent them before a mental health court in order to be released.
Psychiatric patients may also be forced to take anti-psychotic medication against their will. Theoretically, they can even make a patient submit to electro-shock treatment. In Massachusetts, a mental health facility must comply with the Roger's decision and petition the appropriate court for approval. I am told this is a fairly routine matter. The court system merely acts as an assembly line for approving these orders. Once again, who is the judge going to believe, the medical doctor or the mental patient? It's no contest. When I say this, I am not referring to the people who are actively hallucinating and believe that invaders from Mars are attacking.
The only time the state of the mental health system is brought to light is when a patient commits suicide or kills someone. Then there is a public uproar and the psychiatrist or therapist is blamed and in some cases sued. In their defense, a doctor cannot control the behavior of their patient in society. That is not their responsibility as I see it. The mental health professional cannot be held responsible for the actions of their patients, unless they were grossly negligent in some way. We are free and sovereign human beings. In the United States, people are generally allowed to operate freely without undue interference from others. The American attitude is "No one has the right to tell me what to do." It's a slightly different story if the patient states that he or she intends to commit suicide or kill someone. Then the call to duty is activated.
This is where we are in 2013. I'll bet most of you reading this article did not know how our behavioral health care system works. We are still in the dark ages. I have not personally had the experience I just described, but I have been in the psychiatric system long enough to have learned how business is carried out.
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John Backster is an advocate for the mentally ill and an activist for reform in the behavioral health system. Mr. Backster believes that the over reliance on medication as a primary treatment for psychiatric illness has led to a decline in the quality of mental health care nationwide. He is employed as an advocacy speaker for the National Action Committee for Mental Health Care Reform. He considers himself an activist for the rights of the mental ill. Mr. Backster is dedicated to bringing awareness to the alarming deficiencies that exist within the behavioral health care system. His goal is to curb the over-reliance on dangerous pharmaceutical drugs as the preferred treatment for patients with debilitating psychiatric disorders. www.linkedin.com/pub/john-backster/74/503/75a
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