One of my alter-egos, Kookie the Shrink, with New-Age, eco-friendly, portable, non-pharmaceutical, public domain feel-good idea that hasn’t been invented yet.
Everyone knows psychiatrists are crazy. Just ask my deceased mother, who claimed psychiatrists enter the profession to solve their own problems. Fact is, I only began having problems in medical school. My problems got worse after psychiatry residency, when I started practicing psychiatry in a “health care industry” so saturated with sanctimonious hypocrisy that I was astounded. No one seemed to notice or care that externally imposed rules and expectations were making a mockery of the principles I was taught in training. While everyone in the “health care industry” claims to be acting in the patients’ and public’s best interest, the so-called “healers” have become passive tools in a tidal wave of co-dependency that cripples to control and calls it “care.”
While “health care” professionals across the board have succumbed to this debilitating delusion, I feel particularly betrayed by the leadership in my own chosen specialty, because psychiatrists should know better. I believe the psychiatric establishment has abdicated its philosophical foundations. Instead of promoting mental health and self-reliance, it is busy kissing up to the profiteers in government, pharmaceutical and insurance industries, and seeking ever new ways to bind patients and the public to its mind-numbing agenda.
Two concurrent trends show how the psychiatric establishment–which depends on pharmaceutical advertising for its numerous professional publications—is desperately seeking relevance in a drug-pushing world.
The first trend, toward “medication-assisted treatment” for “opioid use disorder,” has been heavily embraced by the psychiatric establishment and the mainstream media. The Friday, August 11, 2017 issue of USA Today claims “Opioids to be declared a national emergency.” Here, we learn that President Donald Trump “’is drawing documents now’ to officially label the crisis as a national emergency.” Such a designation would trigger specific tools for federal and state governments, including grants from the Public Health Emergencies Fund, a suspension of some of the patient privacy provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, and waive Medicaid restrictions on federal funding for mental health hospital admissions.
The second trend is the ongoing fight by the American Psychiatric Association (APA) and its state-level affiliates to stop the push by psychologists for prescription privileges. This is an ongoing turf battle, with bills for psychologist prescribing introduced in multiple state legislatures every year.
The common denominator in these trends is that they are turf battles over drugs. They have nothing to do with caring for patients, mental health, or the mind’s intrinsic self-healing potential. The professional contestants, however, all claim they have patients’ best interests in mind.
Contributing factors abound. In psychiatry, the shift from psychotherapy to medication management has been particularly devastating to professional self-esteem. Psychiatry, now more than ever, seeks to align with the “scientific” foundations of medicine. Meanwhile, insurance and government have delegated “talk therapy” to less expensive psychologists and social workers. What used to be 45-minute psychiatric consultations have become 15-minute “med checks.” Freud has been replaced by Prozac.
This follows a general cultural trend toward quick-fix solutions, with pills becoming the treatment of choice in all specialties except surgery. The rise in illegal drug use can’t compare with the explosion of drugs for medical conditions, vaccines, and pseudo-conditions. Over-medication is a major cause of accidents, drug interactions, and overdoses. Unintentional injuries from falls and overdoses from prescription and illegal drugs are now the fourth leading cause of death in the US, according to one study. Another study cites medical error the third leading cause in hospitalized patients.
The “opioid crisis” is attributed in part to Purdue Pharma’s misrepresenting OxyContin in 1997, when it was introduced, as having low abuse potential. That same year, the FDA approved direct-to-consumer advertising. Pharmaceutical DTC advertising took off at the turn of the century.
That prescription painkillers fall in a different category from heroin—which cannot be prescribed in the US—bears mention, but they are linked by their black market affiliation. OxyContin’s introduction on the market, and its aggressive marketing campaign to specialists and family practitioners brought Purdue Pharma $45 million in sales the first year. That increased to $3.1 billion by 2010, or 30 percent of the prescription painkiller market. In 2007, Purdue pleaded guilty in a federal lawsuit claiming it intended to mislead doctors and patients about its addictive properties. It paid $600 million in fines. The state of Kentucky, the state most ravaged by prescription painkiller and heroin use, has made 12 claims against Purdue, including false advertising, Medicaid fraud, unjust enrichment, and punitive damages. OxyContin costs up to $1/mg on the street, or up to $80 for an 80 mg tablet.
Other reports say fentanyl, a prescription opioid that can be synthesized by drug traffickers, dramatically increases the risk of fatal overdoses. Its deadliest component, carfentanil, is five thousand times stronger than heroin. Add this to the fact that multiple common drugs and alcohol also depress the respiratory center, with a cumulative effect. Benzodiazepines, like Xanax, are often taken along with opiates.
The “opioid crisis,” is now being traced to pharmaceutical companies and to the FDA, according to The Guardian’s latest report. (www.theguardian.com/commentisfree/2017/aug/13/dont-blame-addicts-for-americas-opoid-crisis-real-culprits)
The collusion between the psychiatric community and the pharmaceutical industry to push drugs on a gullible public smacks of a cronyism that few seem to recognize. The FDA-approved “medication-assisted” treatment for opioid use disorder contains two opioids—methadone and buprenorphine—which are also abused. However, the psychiatric establishment, which has sub-specialties in addiction, has a piss-poor success record with addiction treatment and virtually ignores Alcoholics Anonymous and its spin-offs, like Narcotics Anonymous. These are peer run, free, and have a better track record than the “experts” can claim, despite their education and degrees. The APA also ignores non-pharmaceutical treatments like acupuncture, which even the NIH has admitted has utility in chronic pain. Auricular acupuncture for substance abuse has a long and under-appreciated track record.
Where does psychiatric officialdom stand on the mental health advantages of low-stress lifestyles, nutrition, physical therapy, and exercise? Ask, and let me know what you find out.
Crazies ‘R’ Us indeed. The psychiatrists need to get off the drugs and learn to use their minds to heal themselves first.
katharineotto 
Medication is a simple and profitable solution. Purdue and other pharmaceutical companies are more focused on their gains than on our lives.
Rosaliene, My point, too, but they are only riding a wave created by a mass belief in external remedies. People who would rather the companies be profitable than ethical are the norm, not the exception, on Wall Street. Also, the individual (and individual ethics) tend to be watered down in large groups, like corporations, because conscience, like risk, is spread throughout the group.
May we-the-people prevail.
What a great commentary on this concerning trend of over-prescription! Great insight, given your experience in the field.
Steve, Thank you for liking the blog and for commenting. I suppose you are in a position to see how over-medicated vets are. I was appalled at how many prescriptions vets I saw were on. Scary.