How About a Little Inspiration?

Anyone who knows me as a therapist knows that I believe that change is difficult, and that for the most part, people come flawed.  We seem to spend an inordinate amount of time identifying and trying to fix our flaws so that we conform to some standard of how we're supposed to be, and this leads people to feel badly about themselves and have the infamous  Low Self-Esteem.  Or to feel badly that they aren't richer, prettier, smarter, tougher, whatever.  

I think people should come to terms with who they are and say Yup, I suck at this.  And then they should not spend much time thinking about what they are bad at and they should figure out what things they like and how to grow those aspects of themselves and make those characteristics work for them so they can live a more fulfilling life.  

Obviously, there are exceptions, and I don't think people should say, "Yup I'm a sociopath and I kill people, get used to it,"  Nor do I think people should embrace their mental illness without trying to get help.

That said, and with minimal relevance to what I really want to share, I really enjoyed this TED talk by Dan Gilbert on the pursuit of happiness, and I hope you will too.  I wish I could speak like this (maybe with a little bit more air exchange).  And I stole the Seuss cartoon from Kathy's facebook page.  Enjoy.

Psych Meds are THE Problem: A Post for Duane Sherry

Shrink Rap prides itself on being a take-all-comers place for open dialogue about the issues and controversies in psychiatry.  Five plus years, and the feel of our blog has gone through many evolutions.  In the last 6-8 weeks, things have gotten very heated around the topics of involuntary hospitalizations and the question of whether medications cause illness or treat illness.  

I see patients who walk in the door in distress.  The only people who walk in feeling well are those who have been treated by someone else and are coming to continue treatment, either because their shrink moved, they moved, something changed.

Once in a while, someone comes in and they are in distress and they are already on psych meds and I look at the regimen and say "No wonder you feel badly, you're on way too much medicine" and I stop things.  Mostly though, I start new medicines and I see people who were sick get better.  Some people have problems with medicines, but not like I hear people talk about in our comments section.  Here at Shrink Rap, people hate anti-psychotics. Very few patients tell me  that very low dose anti-psychotics bother them.  Medicines need to be added carefully, at low doses, and increased gradually.  The patient is supposed to get better: it they don't, the medicine should be stopped.  Sometimes people end up on a zillion medications, no better, and it's not clear why they are on them.  See: Medications: The Good, Bad & Ugly, and  You're Supposed to Get Better.  These are some of my views on treatment and medications.

It's not unusual that patients come in and casually mention in the course of a therapy session, "oh, I stopped taking the meds."  I ask why.  Side effects?  Felt they were no longer necessary?  I ask if they feel better without them (some do, some don't).  I'm here to help, and since I work in a totally voluntary setting, I may spout statistics, especially to someone with a high risk of relapse who was having no side effects and no problems with the meds and feels no differently off them-- but hey, you don't want to take medicines-- it's fine with me, and I'll hang out with you in therapy anyway. 

Duane Sherry has been visiting us for a while now in the comment sections and he feels strongly that medications are the problem, not the answer, and that people who think they are better are wrong.  He and I are seeing different before & after shots.  He asks if I give informed consent (funny, I do) and thinks people should explore different options such as orthomolecular therapies.  He's posted many links, and something gets troubling about the repetitive nature of it (at least to me) and something gets troubling about the accusatory tone, though he has really toned down the blatant --you're an idiot-- comments. Thank you, Duane, this has meant a lot to me.

So let me give Duane a moment here to get out his message of Meds are Harmful / Psychiatry Sucks here on the main page of Shrink Rap.  Duane, you're still welcome to comment, but please stop with the repetitive links, and please keep the tone respectful.  You might want to consider getting your own blog where like minded people can have a forum.

Duane says:

The drugs numb.
They provide temporary relief.
And that's all they do.

The greatest injury happens in their long-term use... They are addictive, because they meet the medical definition of physiological addiction in two vital areas:

a) Increased tolerance
b) Measurable effects during withdrawal

Have your patients look at the "side effects" more closely... Really look at what the drugs do.

Then see how many want to be placed on them.

Here is Duane's website...funny, no place for comments:
http://discoverandrecover.wordpress.com/wellness

Here are some links Duane likes:

http://www.foodforthebrain.org/content.asp?id_Content=1635
http://www.vitamindcouncil.org/health-conditions/mental-health-and-learning-disorders/depression/
http://www.townsendletter.com/Nov2009/hoffer1109.html
http://www.youtube.com/watch?v=aBjIvnRFja4&feature=channel_video_title
http://www.madinamerica.com/madinamerica.com/Timeline.html
http://breggin.com/index.php?option=com_content&task=view&id=40&Itemid=52
 http://recoveryfromschizophrenia.org/therapists-guide-to-reducing-medications/

Duane, Please put any other links you'd like in the comment section of this post: your personal space on Shrink Rap.  If you'd like, in future comments you can say "I'm putting links up in my space on Shrink Rap" and link back to this post and put them in the comment section here.
 
For the most part, we need to agree to disagree.  I don't believe I am going to sell Duane on the idea that medications sometimes help people live better lives.  And I don't think he's going to sell me on the idea that they should never be used. 

To my co-bloggers: please forgive me. 

Like Looking in a Mirror

Sometimes, I treat people who have the same problems I have in my personal life. It's hard. Oh, it's really hard. If I'm really distraught about something and a patient calls seeking treatment with a similar life circumstance, I will sometimes turn them away and recommend another shrink. But I don't always screen so carefully on the phone, and often "I'd like to make an appointment," will simply get a time and date.

The feelings get really complicated here.

If I feel I've had a role in creating my circumstances, then I wonder as my patients seek my counsel, Who am I to be making any suggestions, much less giving advice? Why are you looking to me, I've screwed up the same situations. Oh, you say, Dr. Jeff said on KevinMD that healthy's Shouldn't Give Advice, but you know, some of us do, and even when we don't, our feelings are often relayed through the questions we ask or the comments we make or don't make, or perhaps by the expressions on our faces, even if we don't say "You should do X." I told a friend once that I feel uneasy, guilty even, in these situations, and he replied, "How do you think I feel?" Did I mention he does family work and was in the midst of a stressful divorce? And I have yet to ask a colleague who also does family work how he managed during the years his own children wouldn't speak to him. Oy, life can be tough, for shrinks just like everyone else.

So perhaps I listen to someone talking about his most personal feelings about a situation, and you know, if I've been there before, perhaps it's good that I can empathize. If I'm in the middle of it, sometimes I listen and the patient's words seem so unreasonable, so unjustified, and yet I recognize them as being exactly my own--it's like having my own anxieties bounced off a wall only to ricochet straight back into my face.

Do I tell the patient that I've been in the same place before? Generally, no. Therapy is about his problems, not mine, and I think in these situations my empathy is clear. I say things that are more poignant and resonant than I might in circumstances where I feel removed. And patients never ask if I've been in the exact same place. On some of the harder things-- things that have no precise quick and easy answer-- I've taken to saying, "Not only don't I know what will fix this, I don't know anyone else who does have the answer." This I can say because I've done my own searching.

I hope I'm reassuring and comforting to people who find themselves in the same places I dwell. Certainly, tripping over a few stones on the path makes one walk a little more gingerly and judge a little less harshly those who walk more slowly. Mostly, though, I worry that I'm a little bit of a fraud just for being in the room.