involuntary psychiatry
Adam Blatner
adam at blatner.com
Wed Jul 12 21:38:14 CDT 2006
Re medication and biological elements in psychiatry. Not the only test, but one I think you'll find amusing: I call it the Oprah Winfrey Show test. I imagine a carefully and fairly-done documentary having been made of the family of the identified patient, what that child or adult's recent experience has been in the last few weeks or months or years. Then I imagine this documentary--built up in my mind by careful interviewing--and attending to the experience of the patient in a phenomenological fashion.. what must have it been like-- then showing this to an average daytime television audience. If they say, "Whoa. If this stuff had been happening to me, I'd be twice as messed up!"-- then I lean towards the need not just for therapy for the client, but more for family therapy, social work, whatever it takes to diagnose the actual stress overload or major psychosocial deficits--and usually there are a number in combination--, and they involve a neglect of building on strengths as much as distinct negative dynamics in the person, key relationships, and various social networks and role supports or channels.
On the other hand, I see some patients who, well, the family may not be perfect, but it's not that bad. Oh, sure, a careful psychoanalysis of either parent will unearth some unresolved stuff, but hey, that's true of any of us. Nor does the family need to be intact, or well off. Lots of not-perfect growing up isn't so bad. So then I start to think about the nature of the symptoms and consider more possible a biological origin. This isn't all--there are scores of other factors, hundreds of them (as I mention on one of my webpages), but it's a start.
About medicating kids. As was mentioned with a primary directive for severe mental illness, there are many in-between solutions. One is to develop a good enough relationship with the parents, where they can call you, and you actually answer their phone calls or emails (! yes!).. and explain it, and make the whole medication thing a trial. You start easy, relatively lower doses, with a clear understanding that you're willing to stop if they're uncomfortable. Then every few days you increase (or give them instructions how to do this) and watch for relief of symptoms or side effects. You're flexible with how they give the medication, and watch for a clear change.
As Rebecca said, a fair number really clear their symptoms--the fairly uncomplicated ADHD kids. Those who get intolerable side effects without significant relief, I back off and either try a different type of medication or follow my motto: When in doubt, take the history again, even more carefully.
There are several sub-types of kids who aren't typical and aren't good responders to the average ADHD medications. Some are Bipolar disorders, though this condition may be overdiagnosed. some have really horrendous life situations and their hyper-ness is really emotional agitation. A few have vision or hearing problems, or other medical problems. Some, depending on the one thinking there's hyperactivity, are really okay, but they're reading disabled or mentally slow or in some other way just in over their heads for the work that's being asked of them.
Well, I enjoy getting into thinking about these things. The one generalization: Don't generalize!
Warmly, adam
----- Original Message -----
From: HV Psychodrama
To: list at grouptalkweb.org
Sent: Wednesday, July 12, 2006 7:35 PM
Subject: Re: involuntary psychiatry
Sometimes I think that we are overmedicating some people, while others, who might really benefit, aren't getting access to the right medication. Working in psych hospitals I have seen psychotropic medications give people back their lives....in the general community I see too many folks being given medication because it is less expensive for managed care to do that than to pay for therapy. Even though there is evidence, for example, that depression is best treated by a combination of the two.
Same thing with children. I have seen children whose parent's resist medication for what is truly adhd that is getting in the way, not only of their schoolwork, but of their social relationships. And other children who are being offered Ritalin because their parents want them to get better grades in a system which doesn;t accept their different learning style. My husband, Eric, teaches kindergarten now but for a while he was teaching first grade. A mother came up to me and told me that Eric had saved her child, because when her child was in kindergarten the teacher wanted him medicated because he couldn't sit still. When he attended first grade with Eric , he didn't have any problems because Eric doesn't believe in asking six year olds to sit still longer than twenty minutes. Fine motor, intense concentration activities are interspersed with gross motor, less intense activity. It would have been a crime to medicate that little boy. The system that insists on asking five and six year olds to sit still for long periods of time is the problem.
On the other hand, I remember a twelve year old girl, properly medicated for the first time, and she said to me, This is what normal must feel like! It was such a relief to her. And for the first time her peers welcomed her.
I really appreciate the thinking that went into offering chronic psychiatric patients the option to create and advanced directive when they are well, for how to treat them when they are ill. Bottom line is the whole system is pretty damaged.
Rebecca
----- Original Message -----
From: Peter Howie
To: Adam Blatner ; list at grouptalkweb.org
Sent: Wednesday, July 12, 2006 7:19 PM
Subject: Re: involuntary psychiatry
Hi Adam,
Some of the arguments that you put forward - or rather the concerns you express are couched in the same terms as people with adhd children - or at least parents and family and teachers of kids diagnosed with adhd.
And the dilemmas are real.
I liked your final comment.
Cheers
Peter Howie
Brisbane, Australia
At 12:13 AM 13/07/2006, you wrote:
This article speaks to an interesting and quite complex problem, a problem of social
policy. As the only MD psychiatrist who is also a psychodramatist in the USA, I have mixed
reactions.
On one hand, I'm somewhat inclined to support such challenges. I agree with about a
third to a half of the arguments of Thomas Szasz, the libertarian psychiatrist. I fear
that there is a tendency to support the convenience of the administration in any large
organization or institution, whether it be a hospital, religious denomination, political
structure, ASGPP, ANZPA, whatever. There are almost always reformers within most large
organizations, and this tension keeps things cooking.
The problem often deals with the folks who are at the edge of breaking the law in
several ways: Those who are chronically homeless and create for those around them, not
only themselves, a hygiene hazard, smells, excretion in public, etc.
Others are clearly suicidal and we must come to a public policy decision as to what
we collectively must do.
Others are a drain on their family for the aforementioned reasons, and the family
members are seeking some relief--these stories can be quite heart-rending. The number of
free-spirited folks who don't hurt anyone is rather limited. The problem often involves
types of harm that are in a fuzzy area of not quite criminal.
The dual-diagnosis problems of illness compounded by drug taking has all become
worse with the growing epidemic of methamphetamine addiction.
And so forth...
I'm concerned because although I am wary about tendencies within psychiatry to
over-medicate, there is an equal if not greater tendency in our culture towards a rather
global anti-psychiatry stance. The best policy requires the spirit of spontaneity,
responding in the moment to the needs of the situation, unhampered by the cultural
conserves of overgeneralizations, abstractions, artificial categories.
I expect to see some further news about this and will be open to questions.
Warmly, Adam
----- Original Message -----
From: <k.kade at att.net>
To: <list at grouptalkweb.org>; <list at grouptalkweb.org>
Sent: Wednesday, July 12, 2006 12:13 AM
Subject: Alaskan Supreme Court recent ruling
> Hello from Alaska. I love this group talk...It helps me feel connected up here in the
> NOrth. This is an article about a recent ruling here...
>
> *FOR IMMEDIATE RELEASE
>
> June 30, 2006
>
> *
> ****FREEDOMS FOR ALL,
> IN TIME FOR THE 4thâ?¦***
>
> Alaska Supreme Court Strikes Down Forced Psychiatric Drugging Procedures
>
> *
> In a resounding affirmation of personal liberty and freedom, the Alaska
> Supreme Court issued its long-awaited decision in /Myers v. Alaska
> Psychiatric Institute/ today. The court found Alaska's forced
> psychiatric drugging regime to be unconstitutional when the state forces
> someone to take psychiatric medications without proving it to be in
> their best interests or when there are less restrictive alternatives.
>
> Faith Myers, the appellant in the case, reacted to the decision saying,
> "It makes all of my suffering worthwhile."
>
> Myers' attorney, Jim Gottstein, said "By requiring the least intrusive
> alternative to forced psychiatric drugging, this decision has the
> potential to change the face of current psychiatric practice,
> dramatically improving the lives of people who now find themselves at
> the wrong end of a hypodermic needle.â?o While he acknowledged that some
> people find psychiatric drugs helpful, Gottstein said he pursued this
> case because, in addition to the drugs' serious physical health risks,
> he is concerned about the rights of those who find them both unhelpful
> and intolerable. He continued, â?oFor people who want to try non-drug
> approaches, the research is very clear that many will have much better
> long-term outcomes, including complete recovery after being diagnosed
> with serious mental illness. This decision restores the rights of
> those people to pursue that potential."
>
> The Alaska Supreme Court decision noted the trial court's concern that
> the statute did not allow the court to consider the problems with the
> drugs even though "a valid debate exists in the medically/psychiatric
> community as to the safety and effectiveness of the proposed treatment
> plan." With this decision, trial courts are now required to consider
> the safety and effectiveness of the drugs in deciding whether the
> proposed psychiatric drugging is in the patient's best interest.
>
> The Court's Decision also makes specific mention that Alaska Statutes
> require the hospital to honor a patient's previously expressed desires
> regarding psychiatric medications.
>
> The full decision can be found on the Internet at
> http://psychrights.org/States/Alaska/CaseOne/MyersOpinion.pdf.
>
> Detailed background about The Law Project for Psychiatric Rights, a
> non-profit organization, is available on the PsychRights web site:
> http://psychrights.org/.
>
> # # #
>
> CONTACT:
> Jim Gottstein
> 907 274-7686
> jim at psychrights.org < mailto:jim at psychrights.org>
>
>
>
>
> James B. (Jim) Gottstein, Esq.
>
> Law Project for Psychiatric Rights
> 406 G Street, Suite 206
> Anchorage, Alaska 99501
> Phone: (907) 274-7686) Fax: (907) 274-9493
> jim at psychrights.org
> http://psychrights.org/
>
> * * *Psych Rights* ®
> * Law Project for
> Psychiatric Rights
>
> *The Law Project for Psychiatric Rights is a public interest law firm
> devoted to the defense of people facing the horrors of unwarranted
> forced psychiatric drugging. We are further dedicated to exposing the
> truth about these drugs and the courts being misled into ordering people
> to be drugged and subjected to other brain and body damaging
> interventions against their will. Extensive information about this is
> available on our web site, http://psychrights.org/. Please donate
> generously. Our work is fueled with your IRS 501(c) tax deductible
> donations. Thank you for your ongoing help and support.
>
>
>
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