On Mental Illness: Medication: More or Less?

By Jack Bragen
Monday August 01, 2011 - 10:34:00 AM

When someone is taking medication to treat a psychiatric illness, there is the issue of how much (the dosage, usually measured in milligrams) of a particular medication ought to be given as well as the choice of which medications. There are psychiatrists who are fairly authoritarian, will order for their patients what medications are to be given and how much; they expect such orders to be followed. This type of psychiatrist doesn’t expect the patient’s intellect to be very intact; and thus explanations for the prescriptions will be brief. This type of bedside manner often feeds the anger of those who are noncompliant. 

When the psychiatric consumer feels that she or he has a voice in the decisions of what, if, and how much medication is to be taken, the outcome may be better. It will also help if the patient is instructed concerning the rationale that guides the decisions of the psychiatrist. The psychiatrist should not assume that his or her patient is intellectually incapable or disinterested in hearing a technical explanation. 

It is hard to know if the final say concerning medication is owned by the psychiatrist or the patient. If the patient for some reason decides that he or she can not abide by the orders of the doctor, there is the foolish option of noncompliance. This option only exists for those in “voluntary” treatment. With noncompliance often comes relapse, which can then result in liberties being taken away. At that point, the final say really is that of the doctor. Trying to defy the doctors often only hurts the person in treatment. If a psychiatrist is really practicing in an unacceptable manner, the best bet is to find another psychiatrist. Trying to tough it out and go without psychiatric care could be a mistake. 

The more recovered a person is, and with more of a track record of cooperation, the less conflict will be created when the patient tries to inform the doctor of his or her needs. Psychiatrists, not unlike police, have certain legal powers and certain responsibilities. It’s all well and good to try to be a rebel and live in defiance; but you ought to save overthrowing “the system” for a time when “the system” is wrong. 

When working alongside a psychiatrist rather than against, you can let him or her know if you are having uncomfortable side effects. You can inform the doctor if you are having thoughts that you suspect might be delusional. You can report mood swings. If you do all of this, the doctor will be able to adjust medication accordingly, to give you the minimum level of discomfort while treating your symptoms. 

Everyone is different. A medication that works very well to alleviate symptoms for one person may not do the same for another. A medication that gives one person a lot of uncomfortable side effects may not affect another person in the same way. 

While there is no such thing as a “sanity pill” which would mean a pill that makes you think properly, there are pills that do something to correct a brain malfunction. If the brain is malfunctioning it means that thinking properly could be impossible, depending on the nature of the malfunction. The pills, while not giving sanity, make it possible for you to find sanity for yourself through unimpaired neural processes. 

There exists the argument that psychiatric medications are like a chemical lobotomy; that they numb the mind and shut down higher functioning. I attend a weekly meeting of people with bipolar, and I can tell you these are intelligent individuals who don’t have chemical lobotomies. The medications have not turned them into zombies. 

If someone appears to be lobotomized who has a mental illness, it is possible, some of the time that too many repeat episodes of the illness have damaged such a person. There could also be other causes. The person could be at an early stage of recovery in which the brain has recently had a biochemical “trauma.” If you look at the same person a year later, that person may no longer seem like a zombie. While there are other people who could have brain damage in addition to a mental illness. I have met numerous people who can process in a very aware and intelligent manner while taking various psychiatric medications. The “chemical lobotomy” argument is mostly uninformed. However, there are instances of a person being overmedicated or on the wrong medicine. This can create a short term “zombie” state. 

There are a few bad psychiatrists out there who have limited empathy for their patients. Some of these practitioners believe that consciousness is an illusion. There are some who worship a twisted concept of what they consider hard science. They believe incorrectly that anything that can’t be measured with today’s equipment (and thus proven) doesn’t exist. It is as closed-minded of an attitude as that of any religious extremist; merely at the opposite pole. However, most of the psychiatrists I have dealt with are kind, compassionate and intelligent physicians (with moderate beliefs and mild manners) who would like to make the lives of mentally ill persons a little better. 

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