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Friday, May 14, 2010

Psychiatric Drugs

Some people who read my blog may get the wrong idea about where I stand on the issue of the use of psychiatric medications, so I want to make something perfectly clear: I am an advocate of the proper use of psychiatric medications, and I think that when used correctly, they are highly effective. I prescribe them to almost all of the patients I treat, including my psychotherapy patients. If fact, my patients who exhibit signs and symptoms of borderline personality disorder would not be able to engage in the type of therapy I do if their high emotional reactivity were not partially controlled on meds.

I even prescribe atypical antipsychotics, even though they can have toxic side effects. I monitor my psychotic patients' for the emergence of metabolic syndrome by checking their blood sugar, cholesterol, and triglycerides (fat). I watch them closely for the emergence of tardive dyskinesia, a neurological side effect that may emerge after long-term treatment with antipsychotic medications. (If you saw the movie "The Dark Knight," Heath Ledger's Joker character's mouth movements look a lot like this syndrome).

Without antipsychotics, many more patients would be living out on the street in cardboard boxes. Additionally, sometimes the atypicals are the only medications that stop certain patients with borderline personality disorder from severely mutilating themselves. They are not my first choice for that, but they are sometimes necessary.

On the basis of my obvious disgust with pharmaceutical companies' disease mongering and the sloppy use of diagnostic terms by many psychiatrists, I hope no one lumps me together in the same camp as Peter Breggin or Robert Whitaker, who grossly exaggerate the dangers of psychiatric medication and distort the studies in a fashion precisely opposite to the way the drug companies do. Nor I am a fan of Tom Ssazz or R.D. Liang, who think that there is no such thing as a psychiatric disease.

BTW, Dan Carlat posted on his blog an excellent description of PhARMA disease mongering by Adriane Fugh-Berman, available at http://bostonreview.net/BR35.3/fugh-berman.php.

One of the drug company strategies that is not described in this article is to label their critics as members of Scientology. Just so you know for certain, I think the idea that mental illness is caused by a volcano god (Xenu) and space aliens (body thetans) is just a wee bit ludicrous, and that Scientology is a dangerous cult. I remember when I was a resident receiving a mailing from them asking me to come and confess my sins. Clever.

I find that doctors who buy into disease mongering are usually well-meaning but incompetent. Some, however, are predators. On an earlier post, I mentioned something called sensory integration dysfunction. I said it was a "mysterious illness" which might have caused confusion to some readers. This "dysfunction" is not recognized as a disorder by the DSM or the International Classification of Diseases, and its descriptions in the literature are highly dubious. There are no adults who are diagnosed with it. Even if it does exist as a syndrome, it is could easily be something that is due to other factors like anxiety. Yet there are doctors who prescribe expensive "treatments" for it to the children of unsuspecting and naive parents. This is shameful.

3 comments:

  1. Dr. Allen,

    So let me get this straight. Because a disorder isn't in the DSM and you don't understand the description, it must not be legitimate.

    I am sure that wasn't your intention but that is the way it is coming across which sounds extremely insensitive.

    Regarding sensory issues being anxiety, picture yourself at the noisiest rock and roll concert. Would you still feel calm?

    People with sensory integration disorder perceive many events as rock and roll concerts. Their brain is not giving them the proper feedback.

    It can also manifest in other ways such as being sensitive to many type of clothes and various touches.

    Yes anxiety is there but it is an underlying issue. That is a key difference it will abate when the SID problems are dealt with.

    They need techniques for dealing with their issues and not scorn from professionals like you who want to label everything they don't understand as a psych issue.

    I agree that professionals can promote therapies that aren't appropriate but that doesn't mean the diagnosis was incorrect.

    Regarding your complaints about Whitaker and Breggin, I am just shaking my head.

    Once again, another psychiatrist refuses to believe that these meds can be harmful. Maybe if you folks were on them long term and suffered horrendous side effects, you would change your tune. I know, I am living in fantasy land.

    Finally, just you know, I am not a scientologist nor am I antipsychiatry. I know of one person whose life was saved by one of your colleagues. But sadly, he seems to be one of the rare people in your profession who truly understands med issues and their dangers.

    AA

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  2. Anonymous,

    "...another psychiatrist refuses to believe that these meds can be harmful?"

    Have you actually read the posts on this blog? I guarantee you that if my upcoming book makes any kind of splash, organized psychiatry and the pharmaceutical companies will not be happy.

    By the way, if a patient has a bad reaction to a drug, I take them off the drug. Usually no harm done (except with antipsychotics, which is why those drugs should only be used with psychotic patients, where there are at present no good alternatives).

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  3. I have a Japanese book on developmental disorders in adults, and it lists some of the sensory integration issues that people with such a disorder can have:

    Vision
    The person thinks light is very bright. They cannot distinguish what they should see from the background.

    Hearing
    The person hears all sounds at the same volume and the person cannot pick out the sound he wants to hear. (Shows drawing of man on the phone with an ambulance going by in the distance; the person on the phone is saying "Hello?" and the man says "Sorry! I cannot hear!")

    Smell
    Cannot handle very well gatherings where there are things like the smell of body odor and beauty supplies and exhaust gas.

    Touch
    They want to wear a certain kind of clothing. They feel that just being touched is the same as being hit hard.
    (Shows a woman who was touched on the back, but who seemed to feel it as though she was hit hard.)

    Taste
    The person is a very picky eater. They have a hard time with foods that use a lot of different ingredients and with condiments.

    Movement
    The person has trouble when it comes to controlling moving quickly, so they are not very good at movement.

    Temperature and pain
    The person doesn't feel pain very much. They are insensitive to changes in temperature. They don't feel fatigue very much.
    (Shows woman in kitchen with blood coming out of her left finger and a knife in her right hand--with the implication that she just accidentally cut herself--and staring at her bleeding finger, showing little reaction.)

    As I understand, these kinds of issues are very common in people with developmental disorders.

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