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01

Struggling with Help that Harms: Working with Young People on Psychiatric Drugs - Page 2

Author // John Breeding, Ph.D.

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Struggling with Help that Harms: Working with Young People on Psychiatric Drugs
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Responsibility

Rob’s mom wants her son to be more responsible, yet the basic message he has received for years (and still is receiving) is that he is not capable of full responsibility because of his mental illness, and needs all these drugs to keep it under control. Responsibility is a core issue embedded in the theory of biological psychiatry that justifies the labeling and drugging of children. According to biopsychiatry, problem behaviors say nothing about social issues, community issues, or physical or emotional issues. The assumption is very simple: Problems are due to “mental illness,” and we are absolved of responsibility to think any further.

Once an individual is labeled with a biologicallybased “mental illness,” his school, his family, his community, and society are all magically absolved from the need and responsibility to keep thinking, to examine themselves, to question the nature of the community, to look at oppression at any level in the society. Instead, everyone can act as if the situation were explained by bad genes or biology causing “mental illness” in the poor soul who is the identified patient. Just as we all are absolved from responsibility to face societal oppression, so also are we absolved from the need to do whatever it takes to care for the individual and support his recovery and well-being.

However much parents or other adults get frustrated and challenge Rob, as a “patient” he cannot be considered fully responsible because he is said to suffer from a disease that renders him irrational and incompetent. Given this logic, psychiatrists are completely justified in giving drugs to Rob and millions of other young people and adults. By extension, they are also justified in the ongoing psychiatric practices of coercion, and administering brain-damaging electroshock. The public is justified in leaving it all to the professionals. Most importantly, everyone is absolved from any responsibility to keep thinking about what is really going on, and to keep working to find ways to create a compassionate society and to respond to individual human needs.


In Session with Rob

I discussed three recent events with Rob that his mother had identified as seriously problematic. In the first, a conflict with his peers at Scout Camp escalated to an intense frustration and a scene with the camp leaders. The second involved an emotional scene in the car with his sister that ended with Rob’s mom taking over the driving from Rob, who was supposed to get his license in a few days. Regarding the third, Rob shared with me that he had used his mental illness as an excuse to avoid recrimination from his band leader for skipping practice due to fatigue from a very late movie night. The strategy worked, but Rob said it was not worth it due to the flack he caught from his mother. To his credit, he also realized it was self-defeating, as he really does enjoy and want to excel in band.

Rob attributed the incidents in the car and at Scout camp to being off his medication; this may be true, but it is clearly not an interpretation that fosters responsibility. In a similar vein, keeping in mind Bruce Levine’s point about resistance to authority, a biopsychiatric attribution undermines individual power, as the spirited motto to “Question Authority” is utterly lost when resistance is interpreted as evidence of mental illness. Rob thinks that being off his medication caused his problems of “impulsivity” and “persistence” to become worse in these two incidents.

Rob’s biopsychiatric interpretation that his behaviors are symptoms of his underlying mental illness not only undermines responsibility, but also disempowers him. It is no doubt true that impulsiveness and stubborn lack of flexibility can be faces of distress, but interpretation of these behaviors as psychiatric pathology regularly interferes with the actual work of conflict resolution and emotional healing. To recognize that, even if these events are colored by emotional distress, Rob is doing the best he can to defend and assert his essential needs for autonomy, self-determination and power. This is a much better way to go. To disregard that at least part of the problem may be due directly to drug effects, including withdrawal, is tragic.


Emotional Hurdles

I have identified three major emotional obstacles to withdrawing from psychiatric drugs—fear, shame and hopelessness. In my experience, the biggest is fear. Rob has had a hard time over the years, and is so scared about his situation that it is very difficult to engage about his drug regimen. Our conversations consist of my letting him know that I am skeptical that he needs all these drugs to function in life.

Rob’s mother is more ambivalent, as she is at least somewhat aware that these drugs have significant downsides, but when we talk about the possibility of withdrawal, her fear comes up strong. Despite her ongoing worry and frustration about her son’s behavior, she is convinced that without the drugs he would be much worse. I can empathize and let her know I understand her thinking on this; I have learned that it is a bad idea to tell people they’re wrong if your goal is to help them open their minds to new information and approaches. It is much better to listen and acknowledge, and gradually give relevant information, such as what is discussed in this article. Regardless, fear remains the biggest obstacle.

Rob’s mother is understandably concerned about how drug withdrawal would demand reserves of time and energy, and likely impinge on Rob’s short-term ability to keep up with the demands of his academic and extracurricular life. The antidote to fear is courage, but the emotion is huge. She is terrified that her son would become even more of a challenge for her, and that he would utterly fail in life if he were to come off the drugs. Rob is several years down the road of continuous drug use, and on a heavy load, so there looms a most daunting path of drug withdrawal and emotional recovery. That it can be done is the hope I carry to contradict the hopelessness she and so many others feel. Helping them work on their fear is a necessary condition for the possibility of success and a good place to start.


Pathways Issue 46 CoverThis article appeared in Pathways to Family Wellness magazine, Issue #46.

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