Posted by kateverbal on August 27, 2000, at 19:04:18
The truth is that there are no easy answers with medications and this psychiatrist is looking for just as easy/simplistic an answer as his patient.
He's also completely missing the dynamic of WHY she might look at her anger as biological - that's a very normal phase to go through after finding that medications can correct the extreme emotions of depression. It's not a complex. She's using what she's learned in the past - maybe going too far, but for all we know or he knows she's right.
In fact, there are some very predictable stages that people go through when they take medications to treat depression (or any other mental illness). The culture and psychiatry go through these stages as well. The psychiatrist himself is at stage 4 (as is the media right now):
Stage 1 - I SUCK. When you're first depressed you believe that your feelings are the result of personal weakness and bad circumstances (or as this psychiatrist puts it "a reaction to people in your life.") Not only are you depressed, but you're depressed that you're depressed (what's wrong with me? why is my life so bad? why can't I shake myself out of it? Why do I keep screwing up")
Stage 2. - THANK GOD! I'M DEPRESSED! If you're diagnosed as depressed and recover with medications you realize that the depression made your reactions excessive - that extreme emotions were caused by some internal pathology. You're relieved and hopeful that your depression is treatable and biological (not your fault). It's an awakening.
Stage 3. - EVERYTHING'S BIOLOGICAL- As life goes on and you encounter new problems, you continue to question whether your feelings are "real" or "pathological/biological" ("maybe all of my negative emotions are some biological disregulation. Maybe I just don't have the correct medication, or the correct dosage. Maybe I'm still depressed, maybe I'm bipolar, maybe I have a rage disorder or ADHD.")
Stage 4. - PSYCHIATRY IS A SHAM - At some point you realize there are some problems medications can't fix. Or maybe medications never fully helped. Or you realize that you've ignored legitimate problems or destructive behaviors while you've been focusing on the biology. Maybe you forget how bad your depression was, stop medications and find you're still all right, or you've been living with side effects you didn't need to. Maybe you start worrying that medications did some long-term harm.
Stage 5. YOU NEVER KNOW - If you have another depression, and you find you have to go back on medications, you realize you're always going to walk a tightrope. You're never going to completely know how much your feelings are caused by biology, behavior or circumstance. You learn to meld ways of thinking, always being wary of the "reality" of your feelings, while at the same time realizing that they may be normal reactions to difficult situations. You're forced to appreciate the value AND costs of therapy, medications, and personal responsibility - and knowing that sometimes there's no right answer. There's almost never ONE answer.
These stages tend to be reactionary, but they're not wrong. The problem is that as people pass from stage to stage they tend to completely dismiss what was learned earlier instead of integrating what they've learned along the way. People who get stuck in these stages are looking at one side of the coin or flipping to the other side without being able to see the coin as a whole.
People stuck on:
Stage 1. Believe they are doomed, life is bad, that if they merely uncover the "reasons" they feel this way they can "get over it." They may spend years in therapy, blame their family, believe they have a physical illness of some kind, and so on. Since the events and circumstances of their life seem so painful and overhwelming it's very hard for them to believe the problem is biological ("but my life really IS awful. I SHOULD be depressed").
Stage 2. Tend to define their identity as "depressive" or "mentally ill." fetishize their medications. tend to think that all of their past problems are due to depression, and biology and may ignore or be truly angry with suggestions that behaviors and circumstances might contribute. "Other" people may be neurotic, but they are "ill." They might denigrate therapy, expecially if they spent years in it before medications. They might minimize normal sadness, and tend to think all people who aren't depressed don't know what true suffering is. Or the corrollary - true suffering must be depression or some pathology.
Stage 3. Believe that medication and biology is the first place to look when they are feeling all sorts of emotional excess. They may stay on antidepressants for years when they don't really need them, react to all sadness as if it were a recurrence of depression, anxiety as a disorder, and in general pathologize or exaggerate normal emotions, accumulate specious diagnoses, and continue to ignore destructive behavior patterns.
Stage 4. Tend to be reactionaries. The "I survived Prozac" set. tend to think they were "duped" by psychiatry and the pharmaceutical industry. They may return to therapy or spirituality as the key to most problems, and begin to trivialize depression, and minimize their own past depression. They believe they know who should and shouldn't be taking medications, and generalize their experience. They point to people stuck at stage #3 as examples of why medications are universally destructive.
If people at stage 4 are of the more balanced persuasion (like Glenmuller) they try to acknowledge that SOMETIMES medications are necessary by defining algorithms - this set of people DO need medications, this set of people should be in therapy. But that's a hopeless task as well - because some people who are mildly depressed or have anxiety truly do (or might) have a biological disorder interfering with the quality of their lives, and some people may really need therapy. You just can't know. Certainly not at this point. .
Personally I think this psychiatrist is a Stage 4 guy. The truth is he can't possibly know whether this patient is experiencing a depressive symptom, an irritable reaction to Serzone or psychodynamic problems she's not willing to deal with. She may be a Stage 3 person looking for a biological cause to every little thing or she may be a Stage 5 person who's come to the conclusion that these feelings are exaggerated enough that there may be a biological problem.
He says he often feels the pull to cover up "what's really going on." He refers to "the true source" of their discontent or unhappiness; the medication's "actual effect." But these are elusive things - and for one who complains about the hubris of technology - the hubris he showed in claiming a greater insight and dismissing his "educated and thoughtful" patient's estimation that the problem was biological seems so much more disastrous.
My psychiatrist has always been a stage 5 kind of guy. When I insisted on clearcut answers for the unknowable, when I was adamant about something, he was given to shrug - "it's possible." I thought at first that was because he hadn't done his research. As time goes by I realize he's not only done his research, but he has the one quality so necessary and so rare in a doctor - he's given up his hubris. He doesn't know. No one does.
> I just ran across this outstanding article and thought it deserved to be read here. It certainly provides food for thought!!! Do you know this guy Dr. Bob? It said he was from Chicago!!
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> Oddzilla
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> Psychiatric Medications as Symptoms
> February, 1997
> by David Kaiser, M.D.
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> A middle-aged woman with a long history of chronic depression came to see me. She was taking Serzone at appropriate doses, and had experienced some improvement. At this visit she complained of frequently feeling angry. She felt her anger was extreme, and was caused by a "chemical imbalance," because "this much anger is not normal." It was obvious to me while talking with this educated and thoughtful woman, that she was experiencing rage toward a number of others, past and present. When I told her the anger was a reaction to people in her life and that she could use this anger to understand herself better, she remained unconvinced, saying she felt out of control and needed some kind medication for it. She was neither violent, nor out of control. She left unsatisfied and angry, as I did not change her medications.
> For this patient, as in all patients, the medication she wanted functioned in her mind as a signifier. In other words, it had a meaning above and beyond its actual effect. For her, a medication represented perhaps a soothing other, a containing other, a form of love, a magical erasure of the past, or many other possible meanings. Only in speaking with her could this be elucidated. In my experience the signifying effect of medication is often more powerful than its real effect. Patients form complex and intense attachments to their medications more because of what they mean than what they do. This is why psychiatric patients often get on and stay on medications, often several at once, even though their actual benefit is questionable. All psychiatrists can relate to the experience of attempting to change medications in patients who are attached to them and resistant to change. Any change threatens some precarious equilibrium related to a complex set of meanings that their medications have taken on.
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> Another way of saying this is psychiatric medications often become symptoms, in the sense of symptoms as signs full of meanings which function to cover over or fill in some lack in a person's life-whether it is a lack of love, desire, purpose or whatever. The psychiatrist, as the dispenser of these medications, is often acting to reinforce the patient's symptoms, further covering up of the patient's ability to see the true source of their discontent or unhappiness. As a result patients often need medications in the way they need their symptoms, as a substitute for what they really need from people. Medications lessen their pain, help them forget, provide a kind of substitute for love, and these substitutes are all the more powerful because they are sanctioned by modern medicine, authority and technology. So it is possible for modern biological psychiatrists to unwittingly act out symptoms and fantasies with their patients, leaving them more alienated from themselves and more dependent on false forms of gratification.
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> The true dimensions of this technologic catastrophe has yet to be learned. Today's patients, discontented, unhappy, fragmented and confused by an increasingly frantic, alienating and violent society, come to psychiatrists for help, only to have their illusions shored up by an increased dose of a technologic fix. They are told they have illnesses that are biologic and can be fixed, instead of being allowed to speak about their unhappiness, to speak about how difficult it is to be a human being, to speak about their suffering, because human beings have always suffered and always will. To believe that we can conquer depression, despair, anxiety with modern technology is the height of hubris and bad faith, a mere childish fantasy, unworthy of any thoughtful person who has their eyes open to human history and modern culture. Psychiatrists have become part of the problem. Perhaps they have always been so.
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> I can already hear the objections. Modern science is beyond such considerations, beyond good and evil, to coin a phrase of someone who knew better. We will go beyond subjectivity, which psychoanalysis depended on, to reach an objective science of human unhappiness. There is an epidemic of "depression," which is a medical illness, and we will stalk it and wipe it out like smallpox, given time, science and public health measures. Everyone with this illness called depression should be on medications. A bit of Zoloft in the water supply perhaps. Then we will all be content and productive. If I satirize here, it is only to bring out the absurdity of what is actually happening. An epidemic of depression? How about an epidemic of cozy relationships between academic psychiatry, pharmaceutical companies and managed care companies? How about an epidemic of psychiatrists who no longer think seriously about what suffering is? How about an epidemic of psychiatrists more interested in power and social legitimacy than in listening to their patients?
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> As a practicing psychiatrist, I often feel the pull of a patient's symptoms, a pull in fact to participate with them to cover up what is really going on. It is a seduction which should be resisted, because it is a seduction to enact a fantasy. Modern psychiatrists have been seduced wholesale, not only by patient's wishes, which are fantasies, but also by positivistic science and technology, which are as much based on fantasy. But it is a measure of how far this has gone that these words will seem extreme to today's psychiatrists, caught up as they are in multiple illusions, increasingly blind to the truth.
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> Please direct any questions or comments to Dr. Kaiser at Mental Health InfoSource.
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> Dr. Kaiser is in private practice in Chicago, and is affiliated with Northwestern University Hospital.
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poster:kateverbal
thread:43848
URL: http://www.dr-bob.org/babble/20000822/msgs/43848.html