ON MENTAL ILLNESS: The Inexactitude of Prescribing Medication

Jack Bragen
Friday September 23, 2016 - 12:34:00 PM

If you are mentally ill and seeing a psychiatrist for medication, the psychiatrist should be evaluating the medication he or she is prescribing. A psychiatrist will try to find out if the dosage(s) are appropriate, will check to make sure that you aren't having an adverse reaction to the meds, and that you are "responding" well to the medication(s).  

One of the things my psychiatrist would once have me do was to stick out my tongue so that he could find out if I was developing tardive dyskinesia. He would also ask me if I was eating and sleeping okay. He would ask me how I was doing in general. He would ask me if I had any "unusual thoughts."  

It is in the psychiatrist's domain to figure out of your meds should be lowered, changed, or raised. However, it is important that you give your own self-evaluation and that you ask for what you want.  

It is our bodies and our minds that are being dealt with. We ought to have a say in our treatment. Mental health treatment ought to be designed to get us well, and to help us do as well as possible. Sometimes it appears that treatment is only for the purpose of preventing us from being a nuisance to society. In these instances, it is as if treatment becomes punishment.  

Psychiatrists usually aren't sadistic people, and thus, if medication side effects are making you suffer, this should be reported. One hopes that the psychiatrist will have an appropriate response. Side effects of excessive medication can be hell. This is drug induced suffering, and this is in the form of extreme physical and mental discomfort. Antipsychotics and some other medications will do this. Most psychiatrists will try to minimize medication-induced suffering, yet will want you to be on an adequate dosage to treat your symptoms. 

In some instances, a behavior that you are "presenting" is caused by medication side effects, and yet, mental health professionals mistake this for being a symptom of your illness--or that you "are doing that on purpose." For example, too much antipsychotic can cause agitation. Yet, mental health workers may mistakenly assume that your agitation is one of your symptoms. (Some of the time, agitation is a symptom; while at other times it is caused by excessive or the wrong medication.) 

In 1984, during my second episode of mental illness (the first had been a year and a half earlier, in 1982) I had a bad reaction to medication in which my lower body contorted, and I couldn't voluntarily control this. This was at an inpatient ward run by Kaiser. Staff assumed this was something I was doing intentionally. Finally, they relented and gave me a big shot of Cogentin (a medication that alleviates some of the side effects of older antipsychotics). When the Cogentin fixed the problem, the doctor realized that, apparently, the antipsychotic medication had caused the problem. I have lingering resentment to this day.  

Choosing psych medications and their dosages is an imperfect undertaking, and involves a fair amount of guesswork. Psychiatrists don't have a definitive way of testing if you are on the right medications or the right dosages, and the best they can do is to look at how you are acting and to listen to what you are saying. We do not currently have a way of knowing what is happening within the cranium of someone with mental illness, other than by evaluating the person's behavior and speech. You can give an x-ray, a thermal image, or an MRI of the brain. However, these tools don’t give psychiatrists enough information and thus aren't used very often on mentally ill people.  

If you believe a psychiatrist isn't doing a good enough job for you, you might want to consider your options; one of them is asking to be referred to another doctor. Most psychiatrists appear to be conscientious, good people who want to help. In spite of that, a particular psychiatrist may not be a good fit for a particular patient. Furthermore, there is nothing wrong with getting a second opinion.