Sunday, March 20, 2011

The Haste To Medicate by Bev Aisbett


The death of a young person, especially when gifted, attractive and bright, is particularly tragic. When that young person is also famous, it seems doubly so.

However, even such a tragedy can be a turning point if what follows is that something is learned from the tragedy and ultimately changed for the better as a result.

Heath Ledger’s untimely death highlighted several issues, not least of which is why he needed and how he gained access to enough prescription drugs to create the lethal cocktail which led to his death.

Ledger’s inadvertent legacy to the world may be that we at last begin to question the haste to medicate which is so often the first response of medicos in treating those who present with emotional crisis.

What are the criteria for assessing the need for prescription drugs in these instances?

How often are other options, such as counselling or lifestyle issues, explored first?

How frequently are patients referred for psychological assessment prior to drugs being prescribed?

A television current affairs program from several years ago featured the story of a teenager bullied because of her large breasts. Subsequently depressed, she was prescribed medication.

Antidepressant medication is designed to rectify and balance the changes in brain chemistry associated with depression and anxiety.

Was errant brain chemistry really the culprit in this example or was the brain chemistry altered by her reaction to the situation?

Self talk, beliefs and attitude are equally potent in changing brain chemistry and altering mood. The type of person most likely to respond to stress in an anxious or depressed way will also have a tendency to think in a rigid, all-or-nothing, catastrophic and self critical way.

Were other options explored first, such as addressing the girl’s self esteem issues?

This also raises the question as to whether it is beneficial to numb the actual experience, no matter how painful.
A pivotal experience can present an opportunity to implement necessary change in a person’s approach to life, shore up resilience and reinforce self worth.

Situations such as this can perpetuate the illusion that drugs are a ‘cure’ for such conditions. Drugs address physical symptoms; they do not change beliefs, thoughts or personality. Exploring the attitude of the sufferer is of equal or greater importance in the recovery process.

It is well known that all medications carry risks, such as side effects, dependency and dangerous interactions with other drugs. The greatest danger, as was the case for Ledger, is overdose.

Those with an anxious or depressed disposition are also those most likely to self medicate with alcohol or street drugs, in particular young men. Men still struggle with acknowledging their vulnerability Men still find it difficult to disclose or discuss emotional issues and are more likely to stifle their discomfort with other substances, rather than express it.

Is it wise to place another drug in their path?

Bureau of Statistics reports indicate that approximately 684,000 people had recently used psychoepileptic medications, which include anti-psychotics and hypnotics as well as antidepressants. Of the former drug group, 47% were reported as sleeping medication. Almost all who used both types of medication did so on the advice of a health professional.

“Doctor-shopping” (visiting several different doctors for prescriptions) may only be spotted by a pharmacist if several prescriptions of the same medication are presented by the same person within a short period of time.

Chats and blogs of young people reacting to Ledger’s death reveal responses ranging from criticism of his stupidity in mixing medications: “What human being with half a brain would ingest all of these at one time?” to compassion for his ignorance of the dangers: “Hey, he wasn’t a chemist!” to condemnation of the doctors who supplied the drugs : “Those drugs, except for one sleep aid, were prescribed. When a doctor gives you meds do you question him? No, because you think it has to be safe since the doctor gave it to you. The problem is that his doctors didn't consider that he’d mix medications. Doctors need to start evaluating patients more thoroughly when prescribing meds.”

So, whose responsibility is it?

There are pressures on both sides of the doctor’s desk in this matter.

The doctor may have an academic knowledge and variable interest or personal experience in these disorders and limited time to spend with someone whose problems need ongoing attention. It would seem reasonable to supply medicinal relief to someone who is undergoing considerable distress.

The patient wants immediate relief and at this stage, will most likely baulk at the idea of putting in the self-monitoring, skill-building hard yards required for recovery.

There is a place for medication, of course. In situations where the sufferer is completely overwhelmed and unable to adequately function, medication can reduce the symptoms to a level where necessary rest is restored and a certain distancing from the problem is established.

However, even in this instance, the emotional issues which have created or exacerbated the problem will need to be addressed to ensure recovery.

Those who are prepared to diligently apply themselves to addressing their predominantly negative and self destructive “inner critic” through education and counselling will often emerge, not only with greatly reduced symptoms but a far healthier approach to life than they held prior to the crisis.

Cognitive Behavioural Therapy (CBT) is one example of a therapy with a proven track record in being of assistance to those suffering with anxiety disorders. The sufferer is encouraged to observe and address negative thought patterns, as well as the behaviours which go hand in hand with these.

Subscribing to the idea that medication is the only path and that we are the victims of our genes and chemicals, rather than our beliefs and attitudes, is to create a sense of helplessness and a “victim” mentality.

In the end, it may be more a matter of encouraging each individual to take greater responsibility for his or her own emotional wellbeing, thus playing a more proactive role in working towards recovery.

Perhaps the most important question that Ledger’s death has raised is whether medication should be the last resort, rather than the first.

By Bev Aisbett—June 2008

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