Search This Blog

Saturday, June 29, 2013

Just Say No? Is informed consent possible in our current mental heath care climate?

My profession has been coopted. Seduced by the siren of medicalization whose sweet medical-model notes lure my colleges into a diagnostic slumber.  While we mental health therapists, psychologists and psychiatrists amble along in a prescriptive haze, it is easy to dismiss from mind the curious and magical roots of the healing arts.  In our current counseling climate, most people seeking therapy expect to receive and are given a clinical diagnosis. A diagnostic code based on the medical model of illness and disease is necessary in order to bill insurance companies who have situated themselves in the lucrative position of reimbursing clinicians for approved therapeutic services.  While diagnostic codes have become a pragmatic reality for the business of therapy, I fear my field is loosing sight of the exquisitely human, relational and mysterious art of psychotherapy.

Symptoms have been rearranged into diagnostic checklists categorized to codify evidence-based practices developed to treat mental disorders, the list of which has expanded decade by decade.  This mental health manifest destiny, we are assured, empowers patients and enables practitioners to use the most scientifically advanced treatments possible.  We are barreling headfirst down the mental-illness-as-a-brain-chemical-imbalance-disease path and I want us to slow down and take a break by a waterfall or in a sunny spot to give us time to contemplate if this road will truly take us where we want to go.

I am concerned the mainstreaming of medical modalities to treat mental illness may be making us crazy.  Or, more alarmingly, is pathologizing reasonable responses to human experiences.  The quest to mold mental illness into a brain disease model has been motivated by multiple social and political forces.  Treatment and profit, once engaged, have married in an opaque market driven ceremony and my profession is doing a celebratory prescriptive waltz. 

Mental illness does exist. Medication is one of many viable treatment options.   My worry is that this one viable treatment is expanding in every direction to the exclusion of other possibilities and to the detriment of all of us.

As a therapist, I am regularly asked to give a diagnosis or make an educated guess about whether or not someone needs medication.  When a client asks me if they should take psychiatric medication because they are depressed or anxious or worried they are bi-polar because they experience ups and downs in mood, a tiny mental health seraph urges me to scream, Hell no! This brain chemical imbalance theory supports fictional disorders designed by a cadre of big pharma sponsored psychiatrists and has absolutely no currently credible medical evidence to back it up and the medications themselves are toxic and deadly!  Another therapist seraph sits on my shoulder and whispers the stories of all the people whose lives have been saved by psychiatric medication.

I am not anti-medication, nor am I an advocate of the Just say no! approach.  I like drugs.  I have taken drugs to treat illness, heal from injuries and trauma, alter consciousness, connect with people, disconnect from the chaos of life, and sometimes just to have a good time.  I am by no means anti-drug.  I am, however, a steadfast advocate of empowered and informed choice.  I am concerned that informed choice is being coopted under the banner of consumer choice.  The psychiatric medication-marketing machine is just too big, too strong, too wealthy and too invested in the medical model for other theories and treatments to be accessible in any mainstream manner.

Mental health treatment is now almost synonymous with a mental health diagnosis and more alarmingly, with a psychiatric medication treatment protocol.  Increasingly, a mental health diagnosis is a required component for services such as having your insurance cover therapy, accessing counseling through a mental health agency and participating in some state funded programs.  School children, for example, receiving supplemental support services often face compulsory conditions: they must obtain a diagnosis and take any prescribed psychiatric medication in order to receive services.  Typically there are no other treatment modalities available.  The brain chemical imbalance disease model has become the only treatment available for many people.  That this is happening when the scientific evidence for a brain chemical imbalance theory is slim to none is disturbing.  There are no blood tests, or any other actual tests, that can prove definitively that someone has a brain chemical imbalance or a mental illness.  The philosophic roots of psychology are being ripped out from underneath our profession.  The relational importance of healing work is becoming a radical outlier.  This concerns me.

People should be involved and engaged in their healing.  In order to do this, we need to be informed, not coerced by science and it’s mental health proxies.  Informed and engaged consent is not unlimited access to direct-to-consumer psychiatric medication advertising.  As a mental health therapist, I continuously struggle with how to support my clients in making informed decisions about medication.  Informed consent is critical.  The massive amounts of pharmaceutical industry messaging that floods professional offices, personal homes, consumer advocacy groups, university research programs and media outlets is staggering.  No other mental health treatment modality has as much professional and cultural influence as the pharmaceutical industry.  How then, is informed and engaged consent possible?

I used to think that offering a space for clients to reflect on their values and beliefs about medication was enough.  Not any more.  Not in the face of medical-model-brain-chemical-imbalance marketing madness.  I can no longer in good conscious simply say, there are many options and medication is one.  The influence of big pharma sits between me and my client luring them with the sirens song of clinical trials, brain imaging photos, late night heat to heart infomercials and bouncing yelling mascots.

I don’t have a mascot or MRI machine. I do however, have the power to speak up and share my concerns about where I see my profession heading and the damage I believe is occurring in the name of scientific, psychiatric progress.  If I remain silent I am, in effect, colluding with an out of control, profit driven industry that has obtained seemingly unregulated access to and control over psychiatry, psychiatric research, psychology and mental health counseling.  I worry that we are pathologizing reasonable responses to complex human experiences and that countless normal behaviors are being diagnosed and treated with medication.  I fear this is creating a mono-social-psychological cultural landscape in which a vast range of human behaviors are equated with disease.  We need radical provocateurs, daring visionaries, audacious artists, outspoken healers, courageous warriors, brilliant loners, mischievous misfits, obsessive mechanics, insomniac bakers, anomic urban gardeners, wildlife saving savants and every other wild child, quiet adult, party animal and solitary scientist.  Nature abhors monoculture.  We are learning this lesson in devastating, bee colony collapsing ways.  Humans are incredible diverse and it is our differences that make humanity possible.  Just as different crops nurture, feed and sustain one another, we pollinate humanity through difference.  

Psychiatry and psychology need to widen, rather than narrow, the enormous range of acceptable normality in behavior, personality, and psychological constitution and embrace both the science and the art of healing.   It will take serious effort to counter the cultural influence of pharmaceutical driven care so that multiple treatment modalities are widely accessible for the general public and that the craft of healing work is recognized as being viable even as it eludes scientific verifiability.  Consumers, clients and clinicians will need to continue to collaborate, speak truth to power, support seemingly “radical” alternatives, mainstream multiple healing modalities, challenge science to research towards collective good, and organize in solidarity across different therapeutic approaches, fields and professions.   

No comments:

Post a Comment