Editorial Note: This is the second in a Doctor Munchausen series of posts – meditations on the fact that medicine is likely the place where the greatest amount of abuse on earth happens – but no-one notices and no-one intervenes.
The post below comes from the foreword to Dying for a Cure, Rebekah Beddoe’s book on what happened her when she fell into the clutches of a doctor. The book came out five years ago. It has just recently been made available in Kindle form – a compelling read for anyone who has ever had something go wrong for them when taking a psychotropic drug or indeed almost any drug.
What is remarkable about books like Dying for a Cure is how women like Rebekah refrain from shopping the person responsible for abusing them. Some will bridle at this use of the word abuse. There is surely a difference between a priest who abuses and a doctor who perhaps gets a treatment wrong? The doctor is well-intentioned. Is s/he?
Medicine involves giving poisons. The miracle of medicine is the ability to bring some good out of the use of a poison. How do we characterize someone who is blind and insensitive to the fact that the poisons they close to force on someone might in fact be poisoning them? How do we characterize all the other good doctors who figure that pretty well whatever it is that another doctor does it falls within the realm of legitimate medical practice?
The Oscar nominated movie The Changeling starts with a clip saying it is a true story – not just based on a true story. In it the horrors of psychiatry are portrayed, pretty well as they have been since One Flew over the Cuckoo’s Nest, through the forced administration of Shock Therapy (ECT) – even though the heroine’s incarceration happened 10 years before ECT was invented.
When the historical detail is so wrong, presumably there has been a calculation that ECT inflicted in this way will best epitomize the fears of today’s viewers about psychiatry. But in fact forced treatment with ECT is now vanishingly rare. In regular psychiatric practice insiders, both staff and patients, are much more likely to fear forcible and indefinite medication with long-acting antipsychotic injections – a treatment that is more clearly brain damaging and likely to turn a person into a zombie than ECT.
The Nice Doctor will see you now
But in terms of the greatest amount of damage done to the greatest number of people, the real abuses, the real dramas, lie in outpatient, or voluntary, or primary care treatment with drugs like the antidepressants. Where ECT when given punitively, as has happened in the past, might be compared to rape as an instrument of War, in countless outpatient and primary care settings an abuse quite comparable to the sexual abuse of children or sexual harassment happens – much more common than wartime rape and probably much more destructive.
The pink section papers of a Mental Health Act aren’t in evidence when we are prescribed an antidepressant. We are free to walk out the door after a consultation, and we think as a consequence that there is nothing to worry about.
But these drugs are available on prescription only, and when we go for treatment we are linked inescapably to the prescriber. In the ordinary course of events for most of us, going to the doctor is like going to the bank manager or the head teacher – we feel a few inches tall, absurdly grateful for the smallest signs of favor, and often completely forget what we had meant to say. This situation is compounded if things begin to go wrong after some treatment starts, when the doctor may quickly seem like our only way out. We become ever more dependent on him, and grateful.
We are unaware we are heading into a medical version of Stockholm syndrome – the puzzling state where hostages are often close to being in love with those who have taken them hostage. If the difficulties we develop are caused by the treatment and the doctor does not recognize that what he has done or is doing is wrong for us, then we become almost hostages to fate.
Abuse or Not?
It can be extraordinarily difficult for any of us to distinguish between the almost identical anxieties, insomnias, and morbid thoughts that these treatments can cause even in healthy volunteers and the anxieties, insomnias and morbid thoughts that may stem from the illness or problem we took to the doctor in the first instance. It becomes effortless for the doctor to blame any developments or worsening on our original problem, rather than his treatment.
Surgeons did just this – blamed the victim – faced with the evidence of memory problems after cardiac surgery, psychotherapists did it in the face of evidence that memories of abuse were sometimes false, and psychiatrists routinely do it when patients get hooked on antidepressants or tranquilizers or get tardive dyskinesia or diabetes from antipsychotics.
In addition to things getting worse for us when a treatment goes wrong, we become isolated astonishingly quickly. If we approach someone for help, we have to risk the stigma of being seen to have a mental problem and then also risk being stigmatized as a loser. We risk incomprehension. Few if any mental health professionals are likely to take our side rather than the doctor’s.
We risk the next prescription being increased to root out the lingering traces of our illogical thinking. No one will call this a reprisal. If for some reason, we are listened to and treatment stops and we get worse, no-one is likely to counsel patience to help see us through what might well be a withdrawal syndrome.
Are you there God? Its me Margaret
The ultimate bind is that our questions will be put in the weighing scales against the scientific answers and found wanting, and what self respecting doctor in an evidence based medicine era will want to be seen to go against the evidence. Can all the guidelines be wrong?
There is no-one on our side who is likely to point out that the so-called scientific evidence has been carefully constructed by pharmaceutical companies, who suppress trials that don’t suit their interests, and who selectively publish data from trials so that even a trial that has shown a drug fails to work and can trigger suicide can be transformed into a trial that shows unparalleled evidence of efficacy.
There is no one to point out that pretty well all the trials published in even the best journals are likely to be ghostwritten. No-one to point out in the case of the antidepressants that pharmaceutical companies have moved dead bodies around in a manner that may well be fraudulent. No-one to point out that lawyers and others looking after the interests of pharmaceutical companies regularly take advantage of medical innumeracy to hide even more dead bodies simply by constructing trials so the results will not be statistically significant.
As in other areas of abuse, if we wait for the abusers to recognize the problem we are likely to wait for ever.
Blowing the Whistle
As in so many other areas from Enron to sexual abuse, it is likely to be women who will blow the whistle. And this is the background against which Rebekah Beddoe’s Dying for a Cure needs to be read. She outlines a drama of seduction, increasing personal confusion, family bewilderment, and finally survival against the odds. But she is also offering a Manifesto.
What she describes will seem unbelievable to many – although not to those who have been through the “system”. Could it happen here in Britain in 2009? Absolutely. Countless dramas of this sort happen in British clinics every day – and not just within the mental health domain. Any area of medicine that has a large number of currently on patent pharmaceuticals, for respiratory or cardiac or other conditions, can be infected in the same way.
The truth is that as 2009 slides into 2010 and beyond we are increasingly less likely to get good medical care – by which I mean when a doctor cares enough about her patient to put the patient’s welfare first even if this means taking on an employing organisation, or the medical or scientific establishment.
Make my day Punk
Dying for a Cure calls out for a movie to be made of it – but we are likely to be waiting a long time for some future Clint Eastwood or Spike Lee prepared to take on this challenge. What stops them?
Unlike ECT, the problems found in Dying for a Cure are ones in which we are all complicit. This makes the project difficult but also adds to the interest. If movie directors are not prepared to take on the challenge, as a matter of honor they should stop making movies like The Changeling or Girl Interrupted, which look brave but in fact play a part in perpetuating the kinds of abuse that Rebekah Beddoe outlines so vividly here.
Angelina Jolie who was almost given ECT in The Changeling now leads a campaign against rape as an instrument of war. We need someone as high profile as her to pick up the fight against pharmacological abuse.