When expert advice can be challenged

So, here I am in the neurology unit of our local teaching hospital, where I have been since Saturday. No flowers or cards, please! I’ll be out in a few days. There is no need for surgery. I’ll be on medication. For life. I’m fine with this because the tests have determined where the problem lies and what remedial action will prevent the problem from happening again in future.

There are no psychiatrists attached to the neurology unit.  Imagine that! If mental illnesses are really brain disorders, why aren’t psychiatric patients treated by the hospital’s neurologists? Well, we all know that psychiatric patients never see a neurologist, and most don’t undergo medical testing to determine the cause of their symptoms.

I wandered down to another floor of the hospital and found the hospital’s glossy magazine on a display rack. This month it features its department of psychiatry and an interview with the head doctor of the day program that Chris attended for two years. The program, as it did when Chris was there, emphasizes early intervention, which seems to be the premise for the interview. The program still focuses on the importance of structure in the patient’s day, the value of integration back into the community, the art and music therapy, etc. Interestingly, the doctor did not mention medications. Perhaps he wanted to avoid an overt conflict of interest since the magazine had a number of pharmaceutical sponsors’ logos on the back page. Medications are a mainstay of the program. The program staff taught my son that medications, for him, are for life.  Early intervention, a good idea, depending on how it is done, I strongly believe is also a way for the program to extend pharma’s revenue stream.

Unsurprisingly, a critical omission in the interview was discussion of importance of the role of the family. It was all about how doctors and therapists help the patient recover and resume his or her role in the community. The critical influence of the family was totally ignored. The family, I know from my experience, being merely passive bystanders who attend the program for 90 minutes every two weeks to listen to the “experts” talk about the program and the medications. It was four years after leaving the program that Chris was finally able to begin integrating into the community. My husband and I had to educate ourselves during that period on how to bring out Chris’s potential; Chris left the program still very much in his shell, and unable to undertake further work or training. He was not its star pupil. The day program did not clue us in how we could help Chris better at home, the environment he was born into and where he spends most of his time.

How much trust should we place in mental health experts to bring out relatives to a state of wellness? How much work should we be willing to do ourselves? Could efforts be better directed by working with self-help and recovery programs that teach families and friends how to help someone in distress from a non-disease perspective?

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