Monday, November 02, 2015

We can do better.


Steven Reidbord MD said...

Yes, we can and should do better. However, this 5 minute video documents well how very difficult it is to treat serious mental disorders effectively. Waxing and waning symptoms aren't obviously a psychiatric condition at first; friends and family don't know whether to wait it out, or insist on treatment (and if so, what kind). Completely understandable self-preservation, e.g., the speaker leaving her partner after ten years, adds further deep trauma. A well-meaning family friend who happens to be a doctor can give a bipolar patient an antidepressant and trigger a manic episode — we are left to guess whether this friend took an adequate history or provided close follow-up. Patients themselves worsen their plight when they use warning shots from a gun to express their misery, landing them in locked psychiatric wards.

We can do better. But if the "we" means society, it's not so easy. Get more involved when a loved one is pushing you away? Stay in a dysfunctional and potentially dangerous relationship in order to support a suffering person? Refrain from "helping" with pharmaceuticals outside of a doctor-patient relationship? Stay away from guns?

The part where psychiatry can do better is when that patient finally comes to see us. Yes, THEN we should not base treatment on a 15 minute interview — really, only 15 minutes for an inpatient admission? — or load him up with 13 psychotropics. We need more "milieu therapy" than crayons and coloring books (although, again, I wonder if the speaker is exaggerating), and we need to do very careful suicide assessments even if — especially if — the patient is motivated to lie in order to be discharged.

And then, even if we as a society do better, and we as psychiatrists do better, it will still happen that some suffering souls will commit suicide. The speaker ends by alluding to "hopeful" treatments that rely less on meds and more on family involvement. I certainly hope we move in that direction — even if it is no guarantee that cases will be identified earlier, that relationships won't break up, that patients won't get the wrong med, and so forth.