Friday, January 29, 2010
Yesterday, in a blog piece on paradigms and psychiatry, I commented that the profession's major assumptions were under serious attack. In response, one of my favorite bloggers Willa Goodfellow posted two perceptive comments which led me to respond that psychiatry is operating under the fatally-flawed paradigm that they have to be the big know-it-alls. Smart patients with proven success are treated as anomalies to be ignored.
I could have written a lot more. Then it occurred to me - I already have. Following is a piece I published 12 months ago. Please read it in the context of yesterday's piece ...
In a previous blog, I mentioned an email interview I recently completed with I Am Bipolar.
"Have you ever experienced negativity or stigma from people who have become aware of your condition?" Michael, who runs the site, asked.
Hmm. Interesting question.
"Ironically," I replied, the worst stigma came "from clinicians and fellow patients, the very people who are also my best supporters."
Clinicians have long accepted me as a journalist. In 2007, in fact, they even honored me with a major international award. But I am not one of them and never will be. Last year, I was invited to give a grand rounds lecture at a psychiatric facility in Princeton. I accepted with some trepidation. It is not my place as a journalist to tell others how to do their jobs.
I showed up with a talk on medications compliance. I'm sure the 50 or 60 clinicians in the audience expected me to blame patients for being too stupid to work the child-proof cap to their meds bottles and such, and indeed I did touch on that. But I also blasted the pharmaceutical industry for aggressively marketing meds that often made us worse rather than better, as well as clinicians who should know better, at the expense of the individuals they are supposed to be serving.
I wasn't just some antipsychiatrist spouting off. My PowerPoint contained reams of citations from the leading psychiatric authorities, including conferences I had attended and first-rank journal articles and editorials. But it was also my duty to wrap it all up and tie it in a bow. With reference to the fact that over the long-term some 70 to 80 percent of patients either drop out of clinical trials or are in some degree noncompliant on antidepressants, mood stabilizers, and antipsychotics, I pointed out the obvious:
"Just sending a patient out the door with a prescription is not treatment."
I wasn't all negative. I mentioned how compliance rates could be improved upon by employing psychoeducation, support groups, various talking therapies, books, websites, and so on. But this did involve the need to build trust with patients and spending time with them, plus being proactive in referring them to other services and sources of information. Again, just sending a patient out the door ...
As soon as my lips stopped moving, the room emptied faster than a high school Latin class at the three o'clock bell. No one approached me for a polite handshake or to follow up on any points I made, or to request more information. Only one person bought my book.
As I said, it is not my place to tell others how to do their job, particularly when nothing I said could be interpreted as a pat on the back, and my discomfort clearly showed in my talk. But even taking all of that into account, I was truly amazed by the magnitude of this group snub. Had I a PhD or an MD or an MSW to my name, I would have been treated with far more civility. But I happened to be a journalist who was also speaking as a patient.
The biggest complaint I get from my readers, I said in my talk, doctors who don't listen. Boy, did they prove me right.
Future blog: Stigma from patients. Stay tuned ...