My 2 Cents On the Practice of Handing Out Happy Pills

Image by edmittance via Flickr

This post has been syndicated on BlogHer.

There are a few things in life that really get me going.  I guess you would call them my pet peeves.  Today I was reminded of one of them as I spent some time on Twitter connecting with my friends.

One of my friends lost her husband not too long ago.  It was a devastating loss for her.  My heart and support went out to her.

While I have never "met" her in person, I can tell from my interactions with her that she is smart, strong and resilient.  She appears to be doing a solid job of dealing with this significant loss and moving on with her life.  I know that she is still grieving, but honestly, I would be more worried if she wasn't.

So when she mentioned today that her primary care doctor thought she wasn't doing very well and offered her antidepressants, I was pissed.  I know that my anger comes from my training in social work--the career that chronic illness has taken away from me.  Even though I can no longer practice being a clinical social worker, all my social work education and experience hasn't become completely lost to me.

Here are the things about this situation that really bother me:

1. Grieving is a healthy process.  I think that the bigger the loss, the longer the time a person needs to process their grief and loss.
2. With the exception of psychiatrists, the majority of medical doctors do not have adequate training to diagnose mental health disorders.
3. If doctors were really trained to diagnose mental health disorders, they would keep a copy of the Diagnostics and Statistical Manual of Mental Disorders (DSM IV) in their offices.  This is a publication of the American Psychiatric Association that lists all the commonly recognized mental disorders and their diagnostic criteria.
4. If they kept a copy of the DSM IV in their office, they would know that grief is not a mental disorder.  In addition, I believe the DSM cautions against diagnosing someone who is grieving with a mental disorder until at least 6 months have past since the loss.

The problematic thing here is that any medical doctor can prescribe psychotropic medications despite their lack of training in psychiatry.  In addition, as a by-product of how dysfunctional our medical system is, many medical doctors do not refer their patients for a psychiatric assessment if they suspect a mental health problem.  No, they "diagnose" depression and anxiety themselves, write a prescription and send their patients on their way.

That is not to say there isn't a role for the medical doctor in the diagnosis of a mental health disorder.  In fact, medical problems need to be ruled out first before a mental health diagnosis can be given.  But I know from my own experiences that often the mental health card is played when a medical doctor can't figure out what is physically wrong with a patient.

I guess it is easier to call someone depressed or anxious and gives them some "happy pills."

My friend's situation worries me.  I also makes me wonder how often this is happening in doctors' offices across the country.

 I know that there are fewer and fewer mental health professionals, like social workers, hired to be part of medical teams.  I think this is a huge mistake.  I believe being able to accurately diagnose mental health disorders and provide specific and appropriate treatment is as equally important as medical care.  Rather than being housed in separate offices, building or locations, I think medical and mental health services need to be integrate.  

My opinion is that adequate health care needs to include both the body and the mind.

I also think that if someone is going to be given a prescription for antidepressants or anti-anxiety medication, there first needs to be a thorough biopsychosocial assessment completed by a team of medical and mental health professionals.

That's my 2 cents.

The Holiday Blues & A Suicide Tweet

Image by christhomson via FlickrPlease note: Today's post is inspired by real life events that unfolded today on Twitter. Identifying information has been removed and tweets are summarized.

A Suicide Tweet

In the early morning hours today, I was made aware by a tweep (a friend on Twitter) that someone had tweeted that she was contemplating suicide. Her previous tweet (aka Twitter message) was that she was lonely and alone for Thanksgiving and wanted people to contact her if they were going to be alone too. Other tweeps were both alarmed and concerned, wanting to do something but not knowing what to do. The tweep in distress was in the USA and the concerned tweeps were in places like the United Kingdom and Australia.

After a few moment of shock and another few moments of contemplation, I decided to get involved and try to help this tweep.

What You Need to Know About Me

I have a sister who lives with chronic depression. I hadn't heard from her in a few years, but in 2003 she called me out of the blue and asked to meet me for lunch. During the meal, she asked me if I would take care of her cats if anything happened to her. This raised a red flag raised and I asked her if she was thinking of killing herself.

When she finally admitted that she was, I convinced her she needed help and took her to the psychiatric emergency room so she could get the assistance she needed.

Trying to Help a Tweet

As I have mentioned before here, I am a retired social worker. While it as not my obligation to get involved in these type of situations, I nevertheless decided that a suicide tweet was a plea for help. I felt compelled to try and respond.

Long story short, through the wonders of the privacy-depriving Internet, I found a way to contact a member of this tweep's family and send them a copy of the troubling tweet. And when another tweep told me the name of the city where they thought this despondent tweep lived, I looked up the number of the police department in that city and called them.

All along, I was corresponding with a concerned tweep in another country. When I reported to them what I had done, I was harassed by another tweep who said that what I had done was wrong and suggested that I was violating this person's right to kill themselves.

No Good Deed Goes Unpunished

Let me be clear. I did not do what I did to be a hero or because I wanted anything in return. I responded to what I thought was a cry for help, in a manner consistent with my training, all along making it clear I was a concerned stranger, acting as a Good Samaritan.

That said, I absolutely did not think I would be scolded, chastised and harass for trying to help. I was completely taken aback, quite shaken and very upset.

Feedback

Despite the criticisms, the people I contacted about this suicide tweet took my reports seriously. I received two call-backs from the police who were desperately trying to find the despondent tweep so they could go out and conduct a health and welfare check. The family member also emailed me back, letting me know they were aware of the situation and that there was a family member with the tweep. When I told the family member that I had contact the police, they agreed to call the officer as well.

Suicide Is an 911 Emergency

Research shows that most people who commit suicide do so in a moment of despair. Many struggle with mental health problems. Many are overwhelmed by their circumstances and in a moment of hopelessness, they think death is the only solution. Troubled and drowning in pain and sorrow, they make a tragic decision that, if they are successful, can not be reversed. They come to an emotionally-charged conclusion that will have a profound impact on everyone they know.

I firmly believe that suicide is not the answer. I believe that people professing suicidal thoughts or communicating that they have a suicide plan are in need of emergency psychiatric treatment. I believe that suicide is a 911 emergency, period.

Taking a Stand Against Suicide

Now that the crisis seems to have passed and I have reflected on the events of the day, I have decided that, presented with this situation again, I would do this again. If someone I know through social media brings to my attention someone's intention to kill themselves, I will stand up and do what I can to alert people who can intervene and help them.

I am taking a stand again suicide. I encourage you to join me.

Resources

• National Suicide Prevention Hotline - (800) 273-TALK (8255)
• National Institute of Mental Health - Suicide Prevention
• National Alliance on Mental Illness (NAMI) - Suicide (this organization supports family members and friends of those living with mental illness)
  

Save Me From My Fear...

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For the longest time, I thought I had some lingering, weird psychological damage from my cancer experience.

Some nights, when I was falling asleep, I would suddenly become fully awake and feel panicked. Then suddenly, my thoughts would focus on the fact that one day I would be dead. A sinking feeling of dread, terror and resistance would then emerged and wash over me.

I'm not dying tonight, or anytime soon, I'd say to comfort myself, as I tried to calm myself down and get ready to try and go back to sleep.

So naturally, I started thinking that my cancer experience left me with an acute fear of death. After all, it's not hard to image that being diagnosed with a life-threatening illness, with death as a possible outcome, as well as knowing fellow patients that died from the same illness, wouldn't make a lasting psychic impression. I guess it's never been hard for me to consider that I might be just a touch crazy after all that trauma.

Plus fear of death isn't uncommon, especially when someone is questioning their spiritual beliefs.

Having cancer shook up the religious foundation from my childhood, an upbringing rooted in Catholic schooling. It pretty much left it looking like the ruins at Ephesus, a place I visited in Turkey in 1990 (see the photo above.) Pre-cancer, I believed in Heaven, Hell and Purgatory. Post-cancer, I have no idea what happens when we die. I know I want there to be something and my worst fear is that there is nothing.

So I have gone along with this whole fear of death explanation for my night-time "death realization" episodes all these years. After all, if the shoe fits... Except yesterday I realized that I might just be terrible wrong. I may, in fact, have put the cart in front of the horse.

What I realized yesterday is that my beautiful, logical and poetic explanation failed to take into account my real, tangible and ever-present health problems. I committed the cardinal sin of mental health diagnosis: I didn't rule out physical causes for my symptoms before jumping to psychological ones. I reached a new level of acknowledgment when I recognized that my symptoms of dysautonomia, fibromyalgia and sleep apnea have conspired to create my night-time fear of death.

Now with this new knowledge, I wonder if perhaps I can be saved from my fear.

Stayed tuned! Tomorrow I will talk more about my revelation and what it means for me moving forward...