Thursday, July 16, 2009

Doctor, Are You "Drugging" or Medicating Your Patients? Antipsychiatry and the War of Words

You have read the blogs and seen the placards a dozen times: doctors prescribe too many “drugs” for too many patients. Psychiatrists, in particular, are popular targets of politically-motivated language that seeks to conflate the words “medication” and “drug”—thereby tapping into the public’s understandable fears concerning “drug abuse” and our need to carry out a “War on Drugs”. Misleading radio ads promise “drug-free” treatment of panic disorder (certainly possible, but not always achievable) and the Internet bristles with the phrase, “psychiatric drugging” (my Google search pulled up 9,310 results). And, all too predictably, any physician who argues that psychotropic medication is often an effective and life-saving intervention is hustled off to the perp-line of “drug company shills.”

All this will not surprise students of language, history, and philosophy. Those who control language are well-positioned to control thought and behavior. If government officials can persuade the public that killing innocent civilians is merely “collateral damage”, they have gone a long way toward justifying the carpet-bombing of a village. If the forces of anti-psychiatry—and they are alive and well—can persuade the public that psychiatry is “drugging” people, they have gone a long way toward marginalizing and discrediting the profession. To understand how powerful the words “drug” and “drugging” are, imagine the feckless campaign that would be waged if the perennial protesters in front of the APA’s Annual Meeting carried signs that read, “Psychiatrists: Stop Medicating Your Patients!”

Is this all merely a matter of “semantics” or—in the parlance of post-modernism—“competing narratives”? Is there any scientific reason to distinguish “drugs” from “medications”? And finally, what are our ethical obligations as healers when medication is administered, either voluntarily or involuntarily? I will have more to say on these matters in a more detailed version of this blog, and in a follow-up piece on the considerable good that psychiatric treatment can do.

Yes, one can argue that, in today’s setting of “mis-managed care,” psychotropic medication is sometimes prescribed too readily, when psychotherapy would be the preferred treatment. And, yes: we need more effective medications in psychiatry, used in more judicious ways--particularly in children, adolescents, and those with dementia, for whom our evidence-base is often shaky. We should be wary of attempts to expand both our disease categories and the labeled indications for psychotropic medications.

Finally, let there be no doubt that, as physicians and healers, psychiatrists have an ethical responsibility to see that medications are prescribed and administered in a compassionate and non-coercive way, consistent with the principles of informed consent and respect for personal autonomy.

But to lump all psychotropic medications in with drugs of abuse is to embrace junk science and junk rhetoric. Psychiatrists need to find a gentle but persuasive language of resistance, in the face of this ploy.

Ronald Pies, MD, Editor-in-Chief

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