Medication Myths Debunked

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Medication Myths Debunked...

By Dr. Mike Shery

We do psychological work all day, every day. Having been in practice
for over 25 years, we are one of the more experienced
practitioners around.
We also read everything we can find that
is written about psychiatric treatment and aging. Unfortunately,
much of it is just plain misses the point.
Where does this come from?
Since psychological treatment is becoming more important
in long term care, the 'psychotropic mythologists' have decided
to “re-join” the medical establishment by touting medication as the answer to every
problem on the planet.
Suggestions about medications fill the
nurses’ stations, the news, many discussions related to resident
depression; and all manner of biological theories are proposed.

In some cases, this is all related to quite helpful
neuro-biological analysis. However, in most cases, it’s related
to a burgeoning “scientism” which sees all human behavior and
emotion as just the result of neuro-chemical metabolism and
nothing more. Consistent with this outlook, they attempt to
'succeed” in “eliminating problem behavior' by readjusting,
re-dosing, mixing, withdrawing and titrating all manner of
psychoactive medications. Reflexively, their very first
thoughts are about what medication strategies to try, not what
problems is the resident facing.

They seem to use “psychotropic-mindedness” in order to generate the “fastest
elimination” of “problem behavior” possible. The truth is...a
knife to a resident’s throat might “work” too...or a gun pointed
at the head… even several six packs may make the resident more
mellow and enjoyable. Many things can “work.”
However, suffice it to say that treatment strategies that automatically
EXCLUDE strength-focused psychotherapies out-of-hand are exactly
the WRONG WAY to do this work.
What's more, this over-reliance
on medication makes the difficult task of enriching a resident’s
depth of experiencing and quality of life even more arduous and
frustrating.

Misplaced Priorities
These well-intentioned physicians and staff always get their priorities backwards. They propose ridiculously simplistic neuro-chemical strategies, while
glossing over the considerable emotional and interpersonal
turmoil of late life that can cause severe emotional discomfort.

Strategically, the initial approach to treatment should be
self-evident. First, do an assessment and discern what
appraisals, thoughts or observations a resident is making that
cause his/her distress. Talk with the family; get their
observations and insights. Then develop a plan of action
involving helping the resident to talk things thru, highlighting
the strengths s/he has overlooked, teaching anxiety, pain and/or
depression reduction strategies. And get it done as quickly as
possible.

Don’t get me wrong. Medication can be very helpful
and necessary for truly biogenetically caused maladies…including
those which exist in psychiatry. To get the most benefits from
appropriately prescribed psychotropics we always maintain a true
collegial relationship with psychiatrists and other prescribing
physicians. We value and use their insights and ideas about
treatment.

However, the main problem is with “psychotropic
mythologists;” those who take things to the extreme. Members of
this camp would have the resident INITIALLY taking various
medications possibly brimming with side effects that may
interact with the other meds that most residents take; this
often makes clinical cause and effect issues very murky.
Sometimes, you end up wasting time fussing with the dosages, the
addition of other medications, the titration of others, the
withdrawing of others, chasing down the causes of additional
symptoms and addressing the frequent complaints of family
members about over-medication. Phew!

The initial goal should be
to quickly address relevant areas causing distress and to
identify and “cue” overlooked strengths. The therapist should
build rapport as quickly as possible and begin addressing the
problem areas and highlighting strengths. Thru this process the
resident gets to experience the precious commodity of sharing
his/her most private thoughts and feelings with the therapist.
This creates a feeling of being valued by the resident which is
ripped away with medication-only treatment. As the resident
begins to resolve issues through conversation, his/her learning
accelerates and powerful self-esteem is acquired because of the
credit that s/he can take by contributing to the successful
process of “healing.” While medication is frequently helpful,
none of these more personal and “substantive” benefits can
accrue without the use of psychotherapy and other behavioral
techniques.

Their Prejudice Shows
In most cases, the writers of
these articles betray their bio-medical prejudices within their
own writings. They do this by advising professionals to
INITIALLY use the most inefficient side-effect prone methods for
treating a psychiatric symptom. They do this WITHOUT EVEN ONCE
MENTIONING the time-tested relatively risk-free option of
psychotherapy or other behavioral treatments. If they really
knew what they were talking about, they'd mention all viable
options, with the least risky ones (which includes
psychotherapy) mentioned first.…all the while presenting the
medication strategy as a simple one with no problems attached
other than just taking a pill or two every night.

Bull...deep substantive psychological recovery involves work, give-and-take,
overcoming resistance, talking about unpleasant things and often
pure exhaustion. To get the deepest and best results, one must
use methods and processes that are considerably more
sophisticated than… JUST, “…here are your pills for
tonight...”

Again, if they took the time to see deeply into
patients, rather than just prescribing something “off- the
-cuff,” they'd take the time to consider and present all manner
of treatment methods possible, suggest using the safest methods
first and convey that to their readers.
Experience and open-mindedness makes a difference
We can manage your mental health program properly. We
know how to identify and treat troubled residents promptly and
we maintain an attentive contact that will keep your potentially
troublesome families at bay.

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Dr. Michael Shery is the founder of Long Term Care Specialists in Psychology, a mental health firm specializing in consulting to the long term care industry. Its website, NursingHomes.MD, provides state-of-the-art mental health treatment, facility staffing and career information to long term care professionals.

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