Shirah Vollmer MD

The Musings of Dr. Vollmer

Do Pills Tell Patients They Are Sick?

Posted by Dr. Vollmer on September 12, 2013

Adam, thirty-two, wants medication to deal with his anxiety. On the one hand, this is a reasonable request, as there are many psychopharmacological options which can assist him. On the other hand, giving him medication colludes with his belief that he cannot cope with the stresses and strains of life. Therein lies the dilemma of the psychiatrist. Medication aids, but also detracts from self-esteem. Yet, some may argue that Adam reaching out for help, through medication, actually enhances his self-esteem, because he is taking a positive step towards wellness. Perhaps the physician should applaud his positive step, but re-direct him to other tools to cope. This narrow path between helping and hurting is the constant struggle in mental health treatment. One must be mindful of this delicate balance so as not to tilt too far in either direction. This will be my message to my students tomorrow.


6 Responses to “Do Pills Tell Patients They Are Sick?”

  1. Ashana M said

    He’s right though–he can’t cope. If he’s come to you, then his degree of distress is unmanageable and he needs something beyond what he already knows to do, whether it’s a new strategy or a new medicine. I think people who see doctors because they don’t feel well know that they aren’t well–the medicine they are given don’t say anything they don’t already believe. Although there are certainly risks to medication, not offering anything only says there is nothing that can be done to help the patient.

    I’m not sure why being given help when you ask for it would lead to lowered self esteem. I didn’t expect to get better all on my own from malaria, and I wouldn’t expect to get better all on my own from crippling depression or anxiety. There is a limit to the body’s ability to heal itself. The idea that we sometimes need help with our health shouldn’t really be news. It’s true that our culture stigmatizes mental health problems–as many cultures do–but we’d clearly all be better off if we stopped doing that.

    • Shelly said

      I agree with you, Ashana. In this fictional account, Adam is asking for help by coming to Shirah. Shirah can help him by both teaching him ways to deal with his anxiety (such as meditation, deep breathing, exercise, therapy), and also give him the medication that he asked for. People don’t usually approach psychiatrists lightly as a first resort. The stigma of doing so would prevent people from openly seeking medications. No, I don’t think pills tell patients that they are sick. Their internal voices do.

      • Hi Shelly,
        I think that I wanted fictional Adam to portray a man who was not used to helping himself, and who, over many years, has come to see himself as helpless and dependent. In such a situation, helping Adam see that this is not the case, can be more therapeutic than giving him medication. Adam is not the typical patient seeking help, but rather, he is a man who has no faith in his own ability to change his life. Helping him see his own potential can be more life-changing than medication. Of course, what I failed to also point out in this post, is that this is not an either/or experience, as Adam can go on medication, and also learn that he has untapped internal resources which have been dormant for too many years. Thanks.

    • Yes, Ashana, I agree. The point of my post is to say that the associations around medication might, in some folks, deepen their feeling about themselves that they are helpless, and for these people, there are times when not giving a medication is a better idea than giving them medication, in that prescribing medication reinforces their sense of dependency. For other folks, giving medication allows them to get through rough times, as you say, was your experience. Understanding that people associate different meanings to medication is one of the many jobs of the physician. This understanding, I am afraid, is getting lost with shorter and shorter medication visits. Thanks.

    • Jon said

      I have a different take on this. Yes, the fictional Adam cannot cope. However, the question becomes, what is the best way to help him cope? Three methods come to mind immediately – talking through his problems, psychopharmacological medications, or a combination of both. Yes, in the analogy of malaria, there is a need for medications. However, for a sports injury, anti-inflammation drugs and rest may be best. In some other circumstance perhaps just rest without mediations. All that said, I agree with Shelly’s final statement, “No, I don’t think pills tell patients that they are sick. Their internal voices do.”

      • Yes, the internal voices do tell patients they are sick, and as such, should the physician consider this internal voice, while pondering the issue of medication? It is possible that prescribing medication only makes this voice louder, when in fact, the point of the intervention is to make this voice get softer. In my experience, quieting this voice is a tall order, as withholding medication brings anger, and prescribing medication brings more dependency, and hence more illness. This is the narrow path, which in my mind, is the challenge of psychopharmacological intervention. Thanks.

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