The meds have been good for her, she said, because she used to come into her kid's room and cry uncontrollably. But isn't that a normal response? What was wrong with it? I mean, she has the right to do whatever she reasonably can to get a handle on herself if she wants to. But I don't see why an MD would resort to sedatives and anxiolytics right away for depression and anxiety which have an understandable origin. Crying is a healthy response to seeing your child near death, right? Why would you want to suppress it? What if her child dies while she's in an induced state of calm, and she finds it hard to manifest her emotions about it? What kind of psychological problems could this suppression of real emotions lead to, thus leading to more medication?
Her other kids are going to therapy, and she said she'll start attending it too. So that's good, probably. But I wonder why that wasn't initiated first, and a long time ago, rather than going straight to meds.
It reminds me, in a way, of the woman I heard talking about how the L&D nurses were telling her to be quiet, stop moaning, and get a handle on herself during labor, or she should really think about getting an epidural. But that was how she was handling herself. Just because a healthcare clinician can't handle sadness or grief or difficulty is no reason to compel a healthy person to anesthetize their feelings—physical or emotional.
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I had a 16 week IUFD. My OB offered to write me a prescription for anti-depressants and sleeping pills. Excuse me? I was supposed to experience the grief. I figured if I took pills, I'd never go through the natural process and then would not actually get through. Not to mention I had never taken meds for mood before, why would I want to start at 34 years old? I'm so glad I refused.
ReplyDeleteThe dad of my sister's best friend died when sis and friend were still in HS. The family doctor immediately prescribed the friend (and the mom and the other 3 siblings) antidepressants. My sister did not understand why this was necessary- she said to me, "Her dad DIED, of course she is depressed! But she should get to feel sad for awhile without it being some kind of medical problem to be fixed!" I couldn't agree more.
ReplyDeleteWhat kind of society are we, that we only allow ourselves positive emotions? Are all negative emotions now pathological? Clinical depression is one thing, but muting all of our sadness, grief, or heartbreak to avoid "icky" feelings is totally another.
Our society probably does have a pathological need to suppress bad emotions, especially if you look at, say, funerals in more "expressive" cultures. But in the case of the individual MDs, I think this is a case of having a hammer and every problem looking like a nail. You know that medications will "fix the problem", or at least keep the patient from bringing it up to you again. And you're not equipped from medical school to handle difficult personal situations. So you treat it medically. :P
ReplyDeleteOverall, I think you make an excellent point --but as a social worker in a children's hospital I've seen parents so incapacitated by anticipatory grief that they are unable to be present for their children. I think there are times when that 'induced calm' in a parent can be helpful to the child. I tend to agree that we as a society overmedicate to avoid emotion, but I also think there's an important role for psychopharmacology.
ReplyDeleteAgreed, M-N, on all counts.
ReplyDeleteAnd, I can go you one: Do you know that some female nursing administrators actually pass around their beta-blockers so they can handle "difficult conversations" and "not be able to squeeze out a tear if (they) had to"?
IS THAT SICK AND NASTY OR WHHHHAAAAAATTTTTT?
I went to a conference a few years ago and had the privilege of hearing speaker Sharon Storton discuss the treatment of trauma. What she said was that patients who experience trauma/extreme grief recover 50% faster with a combination of counseling and medication.
ReplyDeleteUnfortunately, many patients get one or the other and not both, and too often the one they get is a bunch of pills thrown at them for the rest of their lives.
Medication can certainly help some patients maintain perspective when they might otherwise be too emotionally overwrought to function. But I agree, it can't JUST be that.
One of my closest friends lost her son a few years ago. His life was a difficult and traumatic fifteen months (he was born with unpredictable disabilities) and she really struggled to keep her head above water. It was very easy for her to get prescriptions for antidepressants, sleep aids and so forth because any of her doctors could prescribe it, but finding adequate counseling literally took her two years after he passed away. Within a few months after she found her counselor, she was significantly less anxious and sleeping better, with less and less meds. Fortunately, she never gave up looking - but unfortunately, so many others do. How are you supposed to grieve and keep a clear enough head to find help when it's that difficult?
Anyway, that's just my .02 on the topic.
I think as nurses we try to suppress every emotion/reaction from our patients categorizing crying/shouting/writhing etc as an unnecessary distraction that derails us from the job at hand. When in reality if we took the time and allowed ourselves to process the patients' reaction we'd feel too much and walk away, falling to a weeping heap in the corner of the supply room. Or someplace. That's probably why we (some of us) play hard on our time off. Not coming up with excuses or rationalizations but its what we do to shield ourselves on the job so we can feel in private. I think. Nice post. I actually agree with you.
ReplyDeleteOn the whole, I agree with you. I think we have, as a society, started treating emotions and grief as a symptom of a disease (or a disease themselves), rather than normal emotional and physiological way of processing a situation.
ReplyDeleteSometimes, though, a little distance from a painful situation is a good thing. I know that when I was going through my miscarriage, being on a medication that gave me a degree of emotional distance helped me to process the physical aspects of what was happening -- monitor my blood loss, be aware of what tissue I had passed. I was able to grieve before (when I knew I'd lost the baby, but hadn't begun to physically miscarry yet) and after (when the physical act of miscarriage was over), but being slightly dispassionate about it in the moment kept me from completely checking out mentally.
Wow. Excellent points! I never really thought about it. It never occurred to me that somewhat might be encouraged to take medication during the initial phases of grief.
ReplyDeleteI suffered from PTSD and depression due to childhood abuse. I had a great therapist, but resisted medication for many years. The anxiety became so uncomfortable that I gave in to a beta-blocker. After having a good response, a few months later, I started with an anti-depressant. After a year and a half on medication, I have achieved balance in my life and I feel "normal." My son had a psychotic episode and now depends on medication for his mental health and his ability to function in the world. I came from a mindset that all drugs are bad, I have realized that the right drug in the right circumstance can be life saving. But I do believe that drugs should be used with discretion and prescribed by those that really know the person and the drug.
ReplyDeleteI think it's a symptom of our instant gratification society these days. We don't want to be uncomfortable, we want it resolved, and we want it done quickly. We're looking for that magic pill that makes it all go away...
ReplyDeleteIt's a scary thing. At what point will our fear of actually experiencing something unpleasant override our ability to experience life at all? What then, do we all go on soma vacations, a la Aldous Huxley's Brave New World?
Psychotropic medications no doubt have their place. I'm pretty sure blotting out grief isn't that place...
I definitely think we're quick to medicate normal emotions, however I would argue that someone who is going through an intense amount of distress who cannot sleep can be enormously helped by a short-term course of a sleeping aid. Not sleeping makes everything that's bad worse, and makes it harder to cope with the feelings that come on.
ReplyDeleteI agree with RJ about people needing a combination of therapy and medications in situations where grief turns into a chronic condition. Unfortunately, very few of my patients have access to therapy as they are living in poverty and either have no insurance or have Medicaid, which pays so little that there are very few therapists who will take it, and even fewer still who can speak Spanish, Bengali, Vietnamese, or Cambodian. (yes there are a few low-cost or free sites for care, but they are all so over-booked they aren't even taking people on a wait list) I'm a primary care provider and I end up having to prescribe medications in the hopes that they will help, since no other options are available.
I completely agree with you. I have PTSD. And all my MDs want to put me on this drug or that drug. But because of the trauma I've been through, meds make things worse in the long run. I'm having surgery soon and I don't want all those drugs that make you "forget" (versed). Most people think I'm crazy. No one wants to understand that we all process things differently. For me, I need to have a level of awareness for as long as possible. And I need to be able to shake a little. Every one's first inclination is to medicate me, to "calm" me. But so few in the medical profession want to allow me to process. It’s sad. There is so much information out there on non-pharmaceutical ways of helping people with grief and trauma. There is a time and place for everything, but drugs should never be the first choice.
ReplyDeleteWe are an instant gratification society. And that does nothing but suppress emotions and leads to things like PTSD.
Very true Dr. Sharon! I actually do not like the use of drugs without therapy in combination, and only when completely necessary. But it is a very sad fact that medications are widely available, even given away free as "samples," yet excellent, multilingual therapists are like diamonds in the rough. Even rarer an excellent, multilingual therapist who accepts Medicaid or offers reduced fees or payment plans. However, many people(whether fluent in English or not,)are able to, ands DO turn to their community, or place of worship for support in a time of need.
ReplyDeleteAmen, brother. I agree with your parallel between this and birth analgesics/pain/noise. I think we and the medical profession like to fix! But sometimes the journey is what will truly heal, not some pills. I'm not above taking drugs for mood disorders, but as you note here, grief in the ICU over the illness or death of a loved one is not a mood disorder but a natural process!
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