ruthdoctor

Today, Marian at Different Thoughts talks about a movie that’s right up my alley. As always, I wrote a lengthy comment, but then decided it was unfair to place so much text on her site. So I’m posting the bulk of my thoughts here. It gets the really long post I did yesterday away from the top slot, in favor of something short enough that it might actually be read.

Her topic is a film called The Doctor Who Hears Voices. It is the story of a British physician with auditory, persecutory hallucinations. She gets treatment from a psychologist who forgoes drugs in favor of conservative management, including direct engagement with the internal voices.

One point the film makes clear to me is that every case of mental illness is unique. Some who hear voices can learn to cope with them the way most people tolerate negative ‘self-talk’. There may also be those who really need help with pharmaceuticals. At the same time, there are probably doctors with psychiatric problems who should be barred from practice permanently, but there are others who just need to take a break until things settle down. After that they can return to patient care, and bring their experience of real-life hardship to bear on the suffering of those who come to them for help. (For the record, I have abandoned all intention to return to practice, though without doubt I could do it safely and well.)

Many people in our overcrowded culture are not comfortable making such distinctions, or trusting others to do so on their behalf. Evidently, it is easier to simply hear the term ‘mentally ill’ and conclude the person must take powerful drugs, and be removed from all positions of responsibility. (In my post yesterday I wrote about how much society mistrusts the mentally ill.) On the other hand, it is just as facile to decide, on behalf of every psychiatrically disordered patient, that medications should never be given, reasoning that they just cause people to become ‘dumb and stupid’  (the description used by the psychologist in the movie).

Ideally, we would have assessment tools that would allow us to distinguish different situations, and decide (for instance) who requires medications, or who can prudently work as a physician. However, at present no such prognostication is possible. Or perhaps that’s to the best; maybe we need to encourage each person to make their own best choices. Perhaps if we provided ways for people to apply their unique qualities productively, there would be no need to lie on job applications, as the film seems to advocate. I don’t blame Ruth (the physician in the film) for hiding the extent of her symptomatology, by the way; I know firsthand the terror of believing your career as a physician might end. But it would be nice if she could be honest, still practice within her capability with available help if the voices become too intrusive. That would be better than my fear that she might push herself too hard and keep seeing patients at times when she is too distracted to make good clinical decisions. (Of course, you don’t need to be mentally ill to get too distracted to practice optimally.)

In the end, the best short-term answer is education. Each person with psychiatric symptoms deserves to know all options, to talk with people who’ve tried different approaches, and make their own best decision. Medications can sometimes provide the breathing space to learn about one’s dilemma and decide how to go forward in life. This needs to be respected as a valid path, but it should be followed by help and encouragement with tapering off the drugs. Some people elect to stay on pharmaceutical agents long term; they should be be guided toward the minimum number of pills required to keep them functional. We in the consumer community should be supportive of those who decide on that route, and understand that for some medications may be required for a satisfactory life. And there will be those like Ruth who select an alternative track. It is important that the treatment community learn to believe that such progress is possible, and not insist that medications are the only responsible option.

This film is a step in the direction of showing people different possibilities. I would happily play it for someone newly diagnosed with a psychiatric illness, to show one justifiable way to go. I would also emphasize that other choices are equally valid, and that there is no approach that suits everyone. Each person’s illness is unique, and everybody has their own value structure and preferred ways of solving problems. What needs to be avoided, at all cost, is imposing a monolithic strategy on everyone. Unfortunately, things are kind of like that right now. Few patients with psychiatric illness are given any choice in what approach they want. Most are just put on the standard pharmaceutical cocktail, and labelled ‘noncompliant’ if they deviate from it.

But the other side can be a little oppressive too. There is so much free-floating anger about medications coming from those that oppose them, that I have to fight hard not to feel bad about myself because I am still taking drugs. I feel awful enough about the shattering side effects (which as I’ve hinted before I hope to some day have the courage to write about), without also being told that it is wrong to take drugs at all. Even with all my bad experiences, I think it is important to reman open minded about medications. At the very least they can be helpful in the short term, and I seem to still require them to remain more or less comfortable.

I am glad Different Thoughts directed me to this movie. I learned about another mentally ill physician, and saw an example of how even severe psychiatric symptoms can be accommodated without medication.

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