A Pill for Every Ill': Explaining the Expansion in Medicine Use - Literature review Example

? The phrase “a pill for every ill” has emerged in popular culture as a response to the proliferation of pharmaceuticals that address everything fromshyness to obesity. It seems an apt description and represents society’s understanding that no matter what the symptom, problem, or disease, there is a pill to help. However, “a pill for every ill” has not proven accurate for me. In my experience, not only is the phrase “a pill for every ill” untrue, but the pill that cures the psychiatric ill at one time may eventually fail to do so at a later time. Furthermore, my experience has taught me that there are some people and some conditions that simply cannot—or will not—be helped by existing medicines. While some patients respond favorably to antidepressant medications, there remains a contingent that is categorized as “treatment resistant,” or suffering from refractory depression (Malhi et al. 2005). These individuals have initially exhibited reduced symptoms after psychopharmaceutical intervention, and then later experienced the waning of those benefits. Others have never responded to the medications at all. In my experiences, I personally observed patients describing this phenomenon, which most commonly resulted in the introduction of additional medications. Since arriving at the appropriate medication for each patient is a highly individualized process, this practice seemed to be a natural extension of that process. Patients felt hope about their prognosis and were able to place a modicum of trust in the prescriber’s expertise and opinions. At the same time, I wondered whether the patients felt they might be in the midst of a never ending cycle of treatment, treatment failure, and consultation. Also, I wondered whether this type of prescribing might contribute to society’s negative interpretations of the “pill for every ill” notion. Society certainly has an unfavorable view of the “pill for every ill” critique on psychiatry. According to the World Psychiatric Association, the general public views psychiatric medicines as being sedating, addictive, and producing of a drugged effect (2010). Knowing what I currently know of psychiatry, it is hard for me to imagine having this attitude. If I step back and strip away my experiences, I can start to see how this opinion could manifest based on depictions of psychiatric medications in popular culture and mainstream media. Society views this issue through the lens of its presentation through these conduits, and so considers these sources to be accurate to some degree. On the other side of this equation is the physician, who might respond to society’s “pill for every ill” evaluation by taking greater care with what medications are prescribed and under what circumstances. The doctor could also feel pressure to meet this expectation, knowing that patients are arriving in the office with the belief that there is a medication available for the treatment of their symptom. Anxiety disorders are a prevalent psychiatric condition, and this statistic was evident in my personal experiences in psychiatry (Bystritsky 2006). They can also be debilitating and incapacitating to sufferers, especially when treatment has repeatedly failed to produce results. Some studies reveal that as many as one in three patients with anxiety disorder exhibit treatment resistance, and that multiple factors must be considered in the reevaluation of patients that respond insufficiently to standard interventions (Bystritsky 2006). There could be factors of co-morbidity complicating treatment, and personality disorders, environmental factors, treatment motivation, and treatment compliance could also affect the effectiveness of interventions (Bystritsky 2006). I saw this repeatedly in my experience with psychiatric patients; though they took the initiative to see a physician for their symptoms, they described only quasi-compliance with the treatment regimen or were spotty in keeping up with their other, non-pharmaceutical treatments. In the patients that described strict compliance to the prescribed regimen of both medication and psychological therapies, there was still evidence of treatment resistance and tachyphylaxis. Of course, there are treatments other than drugs for many psychiatric conditions. Cognitive behavioral therapy is one of the non-pharmaceutical interventions that has shown promise in the treatment of major depressive disorder, and one study even showed it more effective than medication at six months follow-up (David et al. 2008). Other non-pharmaceutical interventions have also shown promise, including rational-emotive behavior therapy (David et al. 2008). From this perspective, one can reasonably assert that even if there is a pill for every ill, those that prefer not to take it could choose another treatment. In reflecting dialogically upon “a pill for every ill,” there is also a dimension of differing perspectives among varying countries; for example, one study that compared Ireland, Finland, Norway, Spain, and the United Kingdom showed Spain to have the highest percentage of subjects using psychotropic medications and Ireland with the lowest (McCracken et al. 2006). From this, one can surmise that Spanish society seeks and receives psychiatric medication to a greater degree than the Irish do, and so the phrase could have a different nuance in each of those contexts. Where psychiatric medications are rare, does one feel more stigmatized to take them, less willing to approach a practitioner with concerns? As I reflect on my experiences, I can see how “a pill for every ill” may actually be a concept that is harmful to individuals seeking psychiatric care. For example, if a patient enters the therapeutic relationship under the assumption that every symptom has a cure, they may be set up for disappointment or even failure. Regardless of the condition, the patient might become increasingly frustrated with the psychiatrist that seems to prescribe medications that simply don’t work or eventually fail to work. I can’t count the number of times I heard patients saying something like “isn’t there something else you can do?” In the context of the interaction, it was clear that the “something” referenced was medication. Some of the most striking conditions I observed were caused by trauma exposure. It seemed to me that trauma-induced psychopathology was among the most treatment resistant, treatment refractory and absolutely incapacitating conditions. Sometimes, even seemingly commonplace experiences can result in psychiatric problems—take, for example, road traffic accidents (Hobbs et al. 1996). Studies seem unable to determine whether or not immediate debriefing for trauma patients is beneficial or harmful, so following one specific course of intervention and prevention is nearly impossible (Hobbs et al. 1996). Certainly, some of the responses that individuals have to trauma are perfectly appropriate; a loved one dies of a horrible accident and one is expected to grieve appropriately, or one narrowly escapes death by airplane crash and would likewise exhibit some traumatic psychological reaction. In the case of post-traumatic stress disorder, the subject experiences the aftermath of trauma to a degree that it interferes with their functioning. Notably, Summerfield discusses post-traumatic stress disorder as a distress and suffering that, though diagnosable, is not necessarily indicative of a disease or psychopathology (2001). What creates a dysfunctional response to trauma varies from one person to the next, so the disorder related to trauma cannot be predicted. What I experienced during my psychiatric placement was that some people became more depressed or withdrawn in the wake of trauma, while others responded with re-experiencing of the trauma, insomnia or nightmares and night terrors, and difficulty focusing on anything but the memories of the trauma. For the patients suffering from insomnia, it seemed that no pill could allow them to fall or stay asleep. Despite the many medications these individuals were prescribed, they had the same complaints. All of these symptoms were due to either exposure to battle or the intense and prolonged experience of fearing for one’s life. For combat veterans, some have even had symptoms of post-traumatic stress disorder long after the exposure to trauma (David et al. 2006). Some experience hallucinations that reenact combat, and antipsychotic medications are often prescribed for this reason (David et al. 2006). In my experience, this was one of the features of PTSD in this population that had the greatest negative impact on their functioning. In reflecting on the trauma process and response, I am reminded of the grief process and the predictable series of emotions people have expressed after a death or some other form of loss. I wonder, does psychiatry attempt to medicate away the grief process, to provide a “pill for every ill” even when the ill is a valid and necessary response to experiences that should produce psychological pain and suffering in the normal person? I can’t see this as a black and white argument, because I can see how certain circumstances might require medication for trauma response (i.e. a patient gives birth to a full-term, stillborn infant) while others are human experiences that should not be medicated away (grieving the death of a spouse or loved one). Based on my psychiatric placement, I also observed how “a pill for every ill” was less and less accurate as the patient’s diagnosis became more and more complex. Comorbid conditions added new dimensions of treatment, as well as increased potential for drug interactions and side effect problems. Though the increased symptomatology associated with comorbid conditions may encourage a patient’s willingness to seek out treatment, the treatment may be obscured by such concurrent symptoms and even more so by treatment resistance (Shavitt et al. 2010). I found myself frustrated by diseases, treatments, and even patients during this placement. When a patient has a headache or pain from arthritis, a straightforward treatment regimen can be identified. With psychiatry, what works for one person may not work for another, multiple diagnoses make treatment complex, and patients may be hesitant or event completely unwilling to take a “pill for their ill.” Possibly the one most memorable experience I will take away from this relates to the disease of anorexia nervosa. There is a pill for this ill, in that the patient could eat and take prescribed medications. What I observed was a pronounced rejection on the part of these patients to participate in their course of treatment. It seemed that I was watching patients die of their disease when treatment was so close by. Didn’t they know how many other psychiatric patients would desire to have a disease so clearly and straightforwardly treatable? Indeed, some anorexics are willing to die for their disease and do so, even when a pill might have cured their ill (Lopez et al. 2010). My experiences in psychiatry definitely showed me that there is no easy answer for psychiatric illnesses, no pill for every ill. List of References Bystritsky A (2006) Treatment-resistant anxiety disorders. Molecular Psychiatry, 11(9), 805- 814. David D, De Faria L, & Mellman TA (2006) Adjunctive rrisperidone treatment and sleep symptoms in combat veterans with chronic PTSD. Depression and Anxiety, 23(8), 489- 491. David D, et al. (2008) Rational emotive behavior therapy, cognitive therapy, and medication in the treatment of major depressive disorder: A randomized clinical trial, posttreatment outcomes, and six-month follow-up. Journal of Clinical Psychology, 64(6), 728-746. Hobbs M, Mayou R, Harrison B, & Worlock P (1996) A randomised controlled trial of psychological debriefing for victims of road traffic accidents. BMJ, 313(7070), 1438- 1439. Lopez A, Yager J & Feinstein RE (2010) Medical futility and psychiatry: palliative care and hospice care as a last resort in the treatment of refractory anorexia nervosa. International Journal of Eating Disorders, 43(4), 372-377. Malhi GS, Parker GB, Crawford J, Wilhelm K, Mitchell PB (2005) Treatment-resistant depression: resistant to definition? Acta Psychiatrica Scandinavica, 112(4), 302-309. McCracken, C et al. (2006) Health service use by adults with depression: community survey in five European countries. Evidence from the ODIN study. British Journal of Psychiatry, 189(2)161-167. Sartorius N., et al. (2010) WPA guidance on how to combat stigmatization of psychiatry and psychiatrists. World Psychiatric Association. Available from http://www.wpanet.org/detail.php?section_id=7&content_id=922 Shavitt RG, et al. (2010) The impact of trauma and post-traumatic stress disorder on the treatment response of patients with obsessive-compulsive disorder. European Archives of Psychiatry and Clinical Neuroscience, 260(2). Summerfield D (2001) The invention of post-traumatic stress disorder and the social usefulness of a psychiatric category. BMJ, 322(7278), 95-98. Read More