Getting Well and Staying Well: Symptom Reduction vs Functionality

John McManamy Health Guide
  • Donna writes:

    My doctor never asks about function, he always asks about symptoms: mainly, "Are you hearing voices?" and, "Are you paranoid or suicidal?"  If I answer no to those questions, he is more than happy to dismiss me with the same med prescription he gave me last time and set me up with my next quarterly appointment.

    Donna was commenting on my recent post, Talking About Bipolar Treatment. The gist of the post was our doctors are often not on the same page with us. While we are thinking in terms of returning to our lives (functionality) they are preoccupied with keeping us out of the hospital (symptom reduction). Even though the bipolar treatment guideline put out by the American Psychiatric Association most emphatically stresses functionality, this message has yet to filter down to the rank and file.

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    Donna goes on to say:

    [My doctor] is happy if I am a zombie with no feelings at all and has told me so in terms couched in a patronizing tone of voice.  God help me if he puts me back on Zyprexa.  I think I will die.  Will he think the Saphris caused a mild hypomanic episode and be afraid to increase the dose?
    “I want to feel good without any mania or hypomania,” she continues.  “I want to feel the full range of normal feelings without plunging into depression again or thinking I am God's gift to the universe.” Instead:
    What I expect to feel is disappointment again. Disappointment that my doc doesn't understand that I have no life because of this illness. Disappointment that there will be more "medication management" that results in less than stellar results. Disappointment because he will lean back in his chair and tap his pen on the desk and tell me how fortunate I was that Zyprexa "worked" for me.

    Adds Tabby, who was was put on four meds after being diagnosed in 2006:
    I immediately had no ability to think, no ability to concentrate or focus.  Everything was in slow motion, everything was through thick syrupy fudge. I couldn't remember, I couldn't stay awake, and I gained considerable weight.

    Seven months later, unable to mentally perform, she resigned from her job. Meanwhile, her family was commenting that she wasn’t herself. In the end, she decided to wean herself off her minds. It took a month. Within two months, she reports, her “mind was clear as a crystal bell again.  The fog and the fudge was gone, completely gone, and I got another job.”

    Tabby has been on and off meds since then, but never anything approaching the kilotonnage from her initiation into psychopharmacology. Her bottom line:
    I refuse to take any meds - at any dosages - that cause me to be so grossly dysfunctional that I can't work, I can't raise my child, that I can't handle even the smallest daily life function. I refuse to be "treated".  I want to be "helped".  Psychiatrists are only looking to "treat" and very few are looking to "help".

    She concludes:
    The meds are supposed to make one's life better, to increase the quality of one's daily living.  They are not supposed to disable, retard, or dumb down and interfere with one's ability to function while living.

  • This discussion had its genesis with a series of new articles on treatment on my mcmanweb site. There, I observed:

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    Psychiatrists do their residencies in psychiatric units where patients are brought in (often by the police) in a state of crisis. If it's mania, we are bouncing off of walls and ceilings, a danger to ourselves and others. It is a frightening state - of us at our worst - and it is generally a budding psychiatrist's first (and most lasting) impression of an individual who lives with bipolar. A compassionate and caring physician, quite naturally, never wants to see us in this wretched condition again. That's where the trouble begins.

    Later in the same article, I mention how fortunate I was that my doctor placed me on a low dose mood stabilizer. I shudder to think what would have become of me had I been subjected to what Donna and Tabby were subjected to. Back then, I was new to my diagnosis. I knew nothing. Everything was riding on my doctor’s judgment.

    I was one of the lucky ones. My low dose mood stabilizer not only did me no harm, it actually helped me. It slowed my brain down just enough to allow me to start a new life in mental health journalism.

    I need a clear brain to do my job. A moderately depressed brain works fine for me. As does one on the soft side of manic. Just so long as my head is clear. Just so long as when the seat of my pants meets the seat of my chair every neuron housed beneath my skull is fully operational. Yes, every day my depression poses a challenge, as does my tendency toward over-exuberance. For me, it’s the cost of doing business.

    Symptom reduction vs functionality.

    I know all of you reading this get it. The question is - does your doctor?

Published On: January 23, 2011