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Medication Myths Debunked
Medication Myths Debunked...By Dr. Mike SheryWe do psychological work all day, every day. Having been in practicefor over 25 years, we are one of the more experiencedpractitioners around. We also read everything we can find thatis 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 importantin long term care, the "psychotropic mythologists" have decidedto "re-join" the medical establishment by touting medication as the answer to everyproblem on the planet. Suggestions about medications fill thenurses' stations, the news, many discussions related to residentdepression; and all manner of biological theories are proposed.In some cases, this is all related to quite helpfulneuro-biological analysis. However, in most cases, it's relatedto a burgeoning "scientism" which sees all human behavior andemotion as just the result of neuro-chemical metabolism andnothing more. Consistent with this outlook, they attempt to"succeed" in "eliminating problem behavior" by readjusting,re-dosing, mixing, withdrawing and titrating all manner ofpsychoactive medications. Reflexively, their very firstthoughts are about what medication strategies to try, not whatproblems is the resident facing.They seem to use "psychotropic-mindedness" in order to generate the "fastestelimination" of "problem behavior" possible.

The truth is...aknife to a resident's throat might "work" too...or a gun pointedat the head… even several six packs may make the resident moremellow and enjoyable. Many things can "work." However, suffice it to say that treatment strategies that automaticallyEXCLUDE strength-focused psychotherapies out-of-hand are exactlythe WRONG WAY to do this work.What's more, this over-relianceon medication makes the difficult task of enriching a resident'sdepth of experiencing and quality of life even more arduous andfrustrating. Misplaced PrioritiesThese well-intentioned physicians and staff always get their priorities backwards. They propose ridiculously simplistic neuro-chemical strategies, whileglossing over the considerable emotional and interpersonalturmoil of late life that can cause severe emotional discomfort.Strategically, the initial approach to treatment should beself-evident. First, do an assessment and discern whatappraisals, thoughts or observations a resident is making thatcause his/her distress.

Talk with the family; get theirobservations and insights. Then develop a plan of actioninvolving helping the resident to talk things thru, highlightingthe strengths s/he has overlooked, teaching anxiety, pain and/ordepression reduction strategies. And get it done as quickly aspossible. Don't get me wrong. Medication can be very helpfuland necessary for truly biogenetically caused maladies…includingthose which exist in psychiatry.

To get the most benefits fromappropriately prescribed psychotropics we always maintain a truecollegial relationship with psychiatrists and other prescribingphysicians. We value and use their insights and ideas abouttreatment.However, the main problem is with "psychotropicmythologists;" those who take things to the extreme. Members ofthis camp would have

the resident INITIALLY taking variousmedications possibly brimming with side effects that mayinteract with the other meds that most residents take; thisoften makes clinical cause and effect issues very murky.Sometimes, you end up wasting time fussing with the dosages, theaddition of other medications, the titration of others, thewithdrawing of others, chasing down the causes of additionalsymptoms and addressing the frequent complaints of familymembers about over-medication. Phew!The initial goal should beto quickly address relevant areas causing distress and toidentify and "cue" overlooked strengths. The therapist shouldbuild rapport as quickly as possible and begin addressing theproblem areas and highlighting strengths.

Thru this process theresident gets to experience the precious commodity of sharinghis/her most private thoughts and feelings with the therapist. This creates a feeling of being valued by the resident which isripped away with medication-only treatment. As the residentbegins to resolve issues through conversation, his/her learningaccelerates and powerful self-esteem is acquired because of thecredit that s/he can take by contributing to the successfulprocess of "healing." While medication is frequently helpful,none of these more personal and "substantive" benefits canaccrue without the use of psychotherapy and other behavioraltechniques.Their Prejudice ShowsIn most cases, the writers of these articles betray their bio-medical prejudices within theirown writings. They do this by advising professionals toINITIALLY use the most inefficient side-effect prone methods fortreating a psychiatric symptom. They do this WITHOUT EVEN ONCEMENTIONING the time-tested relatively risk-free option ofpsychotherapy or other behavioral treatments.

If they reallyknew what they were talking about, they'd mention all viableoptions, with the least risky ones (which includespsychotherapy) mentioned first.…all the while presenting themedication strategy as a simple one with no problems attachedother 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 oftenpure exhaustion. To get the deepest and best results, one mustuse methods and processes that are considerably moresophisticated than… JUST, "…here are your pills fortonight..."Again, if they took the time to see deeply intopatients, rather than just prescribing something "off- the-cuff," they'd take the time to consider and present all mannerof treatment methods possible, suggest using the safest methodsfirst and convey that to their readers.Experience and open-mindedness makes a differenceWe can manage your mental health program properly. Weknow how to identify and treat troubled residents promptly andwe maintain an attentive contact that will keep your potentiallytroublesome families at bay..