Monday, May 21, 2007
L. Ron Hubbard Can't Save Your Life
Thanks to Tom Cruise, most people know by now that the Church of Scientology isn't fond of psychiatrists or psychotropic medications. They're not alone of course. Various other religious sects and cults, as well as most practitioners of "alternative", "wholistic" or "complementary" medicine, feel the same way, if each for different reasons.
My exposure to the psychiatric model of mental health dates back to the mid-1990's, when I worked as a non-degreed social worker with impoverished adults on New York's Lower East Side, and later with adolescent gang-bangers in Santa Cruz, CA.* And my experiences led me to believe that there are definitely valid criticisms to be made about the psychiatric model, and more specifically the ways in which it's used by public mental health authorities.
First, the use of medication, instead of being a last resort, is a first response, often consisting of trial and error "cocktails" of various psychotropics until the targeted symptoms are controlled. With the adolescent boys I worked with, it was often a "prescribe ritalin first, ask questions later" approach. Lifestyle and nutrition (specifically, the enormous amounts of sugar and caffeine the kids consumed) was quite simply never addressed, which was surprising given the clear correlation that exists between sugar, caffeine and hyperactive behavior.
Second, I was struck by how many of the symptoms and "disorders" I saw diagnosed every day were poverty-related. That, combined with the fact that the mental health team I worked with in Santa Cruz was part of a Children's Mental Health/Juvenile Probation pilot program, suggested that the psychiatric profession was being co-opted by the state to buffer the police response to social and behavioral tensions that are in large part a result of inequalities in wealth distribution. In other words, instead of being a societal condition with political responses, poverty has increasingly become a psychiatric condition with medical responses.
But I think it's important to recognize that while the psychiatric model isn't perfect, it is in many cases very effective. Especially, as studies have shown, when used in conjunction with psychotherapy and alternative treatments. And while diet and exercise can certainly contribute to a patient's well-being and should be integrated into a comprehensive mental health treatment regime, psychotropic medications have offered hope where previously none existed for treating extreme psychiatric disorders that border on or enter into psychosis.
Finally, some people just might not want to change every aspect of their diet and lifestyle in order to manage what are nevertheless debilitating symptoms. That's their right, whether Tom Cruise likes it or not. Like cancer treatment, it's irresponsible to advocate for an either/or approach to what remains a personal decision between a patient and his or her doctor. Because for all of psychiatry's faults, a good psychiatrist is still more effective than a bad guru.
*At the time, I took a much more rigid, "anti-psychiatry" position than I do today. I was one of very few people (I hesitate to say the only person) advocating for the integration of complementary health practices into the public mental health system. I remember the snickers and condescending comments I got from colleagues when I proposed Yoga, Tai Chi and vegetarian cooking classes, as well as guest lectures on acupuncture, Chinese herbalism, and meditation at the residential program where I worked. And yet, not only were the programs well-received, they were effective in teaching techniques for emotional well-being that the residents found very useful.