Medication Skepticism

Q: My therapist told me to stay away from psychiatrists. All they do is fill you up with mind altering meds. What do you think? A: Well….your therapist may have a point. But maybe not! I actually spend about 50% of my work getting patients off unnecessary meds. But most psychiatrists today are trained with the ‘medical model’ and so they will jump all too quickly to prescribing. However, therapists also need to be careful. Some of them may be so “anti-medication” that they could be depriving patients of good care. I’ve seen all too many patients over the years who have been locked in therapy with no resolution of debilitating panic, or compulsive behaviors, or deep penetrating depressions. What we think we know in 2022 is that there are certain psychiatric conditions that seem to be strongly based in biology. In other words, it’s in one’s DNA. These include panic disorder, obsessive compulsive disorder, severe depression, bipolar disorder. Therefore, logic says that a ‘biological agent’ (a medication) can be an extremely effective part of the treatment. When I started my psychiatric residency, I too was skeptical about medication treatment. But over the years I’ve seen the dramatic positive power of medications that have literally saved lives. Bottom line: it is crucially important for psychiatrists to know when NOT to prescribe meds and when to refer patients to therapists. Conversely, therapists need to know when therapy alone is not enough and then to refer their patients to psychiatrists for a medication evaluation. And certainly, all mental health professionals, no matter their approach, should not neglect the importance of spirituality in their course of treatment.

Why Are You Here?

Q: My 20 year old daughter tells me she has five psychiatric diagnoses. Is that possible?

A: Your question makes me think of a dialogue I had when I first met with a new patient at the psychiatric hospital:

Me: “Nice to meet you, Susan. Please tell me why you are here.”

Susan: “I have MDD, OCD, PTSD, ADHD, BPD!”

Me: “but, Susan, why are you here?”

Susan: “I just told you!”

Unfortunately, we find ourselves in a mental health world where many people live in a mindset of labels and pathology. Some people, sadly and for a variety of reasons, prefer to look at themselves as unwell; and then it becomes part of their identity.

Please don’t misunderstand me: certainly there are those who suffer with mental problems, problems that have labels to them. Hopefully, these conditions can be correctly diagnosed by careful clinicians. And in today’s world we have effective medication and therapy treatments that can turn lives around.

The sages say that in a given day a person could have nine good things and one bad thing happen, and yet at the end of the day the mind will focus on the bad thing. Such is the human condition for many.

A positive outlook in life requires work. Certainly an awareness, a connection to one’s soul, can help tremendously.

To answer your question, yes, it is possible to have more than one psychiatric condition. (Think of the physical world where one may have asthma and diabetes and high blood pressure). But five, like your daughter states, is highly unusual and unlikely. I would guess there’s much more that meets the eye here for her.

Nonetheless, I suggest that you not challenge her on her statement. My guess is that she is reaching out to you, wants you to take the time and get to know her better. So yes, simply talk with her. Listen carefully. Show empathy. And in that way, you can help her to get to know her real self.

-Dr. John Yaakov Guterson

'Well-Being Therapy'

Q: I’ve heard a lot about ‘Well-Being Therapy’. Sounds fascinating - please tell me more.

A: ‘Well Being Therapy’ is a unique approach that focuses on positive experiences rather than just looking at what is wrong. It was developed by Giovanni Fava, M.D.

Patients keep an active diary and write the things in their life, past and present, that are going well. Their strengths, their successes. From there, they are then better able and stronger to look at what happened that stopped their good feeling.

And to do something about it, usually through cognitive restructuring.

This focus on well-being instead of distress leads to a more positive view of oneself. One starts to flourish, gains more resilience, is more willing to take on challenges, has better relationships. A sense of self- determination; a belief that life has meaning and purpose.

In the words of Rabbi Menachem Mendel Schneerson:

“Birth is G-d saying that you matter”.

We are not here by accident. Each person matters, is irreplaceable. And we each have our unique mission to fulfill. Uncover what that is -and - go for it!