To Medicate Or Not to MedicateNEW YORK CITYVOICES: November/December 2001
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By Douglas Munsey, MD, Adolescent Unit, Holliswood Hospital
From a speech presented at the Children & Adolescents Conference, June 4th 2001 at Fordham University Graduate School of Social Service. Alternative treatments should not be used without doctors approval.
There is no pill that can substitute for the sort of healthy human interaction that builds genuine self-confidence and self-esteem. Medications usually do not obviate the need for psychotherapy.
There are situations in mental health, however, when other people's love and support—though of crucial importance—doesn't turn out to be sufficient to solve the problem. Our society generally has no problem with the idea of seeking treatment for "medical" problems—anyone who has high blood pressure or diabetes and fails to take their appropriate medications is seen as being irresponsible and careless. But the realm of our mind and emotions seems often to be held to a different standard; although considerations of willpower and spirituality rarely stop a person from taking non-psychiatric medications, they are often major issues in psychiatric situations.
The great importance of discipline, will power and spirituality, I feel, are givens in life. But, though necessary, there are times in mental health—just as in cases of "physical" illness—when they don't appear to be sufficient to remedy the problem.
We all know that one way to make someone feel tortured is to hammer on them for not doing something that—in fact—they are incapable of doing. The dilemma is always where does laziness and lack of self-confidence end, and true incapability begin.
Things become even more intense when children are involved. Children are fast to blame themselves, and to believe even unfair criticisms leveled at them. It's particularly dangerous to make a child feel responsible for controlling uncontrollable symptoms, because this can contribute to their developing an image of themselves as incompetent that can have a profound effect on the quality and nature of their adult life. Please understand that I am not saying that kids shouldn't be held fully responsible for behaviors within their control!
Many kids grow up in very difficult circumstances and/or seem to be affected very negatively by their peer group. As a result, part or all of the triad that strikes terror in the hearts of parents may become active issues: academic disinterest, drugs, and sexual promiscuity.
As a general rule, these are life issues that call for an approach through communication rather than chemistry. Unfortunately, if detrimental behaviors and attitudes go on for a long time, they can become more and more ingrained: more difficult to address successfully through just talking and reasoning; and pose an increasingly urgent threat to the child's life. There is no medication that will magically improve a child's willingness to follow parental advice. Medication may be useful in such cases if rage, impulsivity, and mood lability have come to be persistent behavioral features.
"Addiction" is another commonly expressed concern that crops up in discussions. Just as addiction to drugs and alcohol can ruin lives, so can "addictions" to certain outlooks on ourselves, others, and life in general. These addictions come out of difficult life experiences, and not out of a bottle. There are times when they reach crisis proportions and must be dealt with aggressively, before the person's sense of self suffers too much, and their quality of life and ability to function are too severely compromised.
Unlike street drugs and alcohol, psychiatric medications on the whole do not seek to numb people to, or help them forget, their problems. They seek to restore a level of function and clarity of perception that allows the person to live a fuller and more functional life, so those problems can be successfully confronted rather than avoided.
Duration of treatment is another concern: will I or my child have to take this stuff for the rest of my/his/her life? In fact, there's no reason to automatically assume that this will be the case. The answer to this question is always specific to the person's unique situation. However, it is a given that the lowest effective doses be used, and that the need for continued medication be
periodically regularly reviewed.Alternative medications are another frequent source of inquiry. Studies at Harvard have suggested that omega-3 fatty acids may function as well as a mood stabilizer as any prescription drugs used for that purpose these days. However, I would underscore the fact that herbal preparations, such as St. John's Wort, are also drugs with a mechanism of action, and can also produce side effects and have significant drug interactions. The point to remember is that herbal preparations are not all necessarily innocuous—we still need to learn more about them.
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