The overriding concern of psychiatric services till date has been management of mental illnesses– by any number of drugs and services. Whatever counseling or therapy has accompanied these services, the dominant role has still been played by the model offered by psychiatry (in other words, the DSM)
I am not writing a critique of psychiatry here, because it is unnecessary. It may have had something good to offer, to a lot of people, facing crises, but it does not offer recovery as an option- that is a certainty. If you are willing to submit to its ideas and experiments, newer and newer drugs will keep appearing and they will keep promising newer outcomes; NOT RECOVERY among them.
When recovery is not even an agenda for psychiatric services, to expect that people will get well and fully recovered, just by taking psychiatric drugs and nothing else, is nothing but ignorance. I for one, know from myself and scores of others that, no psychiatrist ever tells a patient that they can go off medication or they can be on their own without drugs (unless they are working in government hospitals, where they are not always working for profits). The bigger issue is that patients and their families keep looking up at doctors to give them the cue that they can be off drugs! They never have the courage to take their own decisions- for everyone who has known psychosis or extreme mood states knows the perils of them. Of course, even if family caregivers tell psychiatrists that their loved ones do not require medication, because the initial symptoms have subsided, they do not pay heed. From self experience, I documented this as part of this research article in 2011.
So whose focus should recovery be, if patients have to recover? I just asked my mother this question awhile back. In fact, in the blog post I wrote before this, about the dilemma of caregivers, I had mentioned about my mother being a very active and militant sort of a person, which she is- not to take any nonsense, to give speeches wherever need be, and in general to stand up for causes that she finds justification in (quite radical actually). Even her mother was a radical in her own time, who the then PM of India, Lal Bahadur Shastri (or was it Jawahar Lal Nehru?) had invited to be part of the parliament. She had declined because one of her children was quadriplegic and there was no one to look after him. In other words, their children have been one of the key priorities of women in my family.
No matter what her personal position in other domains of life, it was she who was more recovery- focused than me! I was in no condition to even consider recovery as an option, for with great perseverance I had come to a point where I had achieved a certain measure of ‘stability’ (an absence of diametrically opposite mood states), and I knew that with the given dosage (valproate mostly) I could go on and on for years. I would not worry about any more fluctuations. It was another matter that for years the fog in my brain would not lift, the heart was always heavy, the body always tired and moods relatively low- but I accepted that as a part of being ‘bipolar’, and disorder was there to stay.
Mummy would not accept that. From ayurveda to homeopathy, to any other system of medicine that could yield results, including naturopathy, yoga or what have we, any new- found person, anything, even an astrologer would work- as long as her child could get some succor. I do not really see that tenacity in a lot of people, who are willing to let medical science decide the course of action for them. No doubt, the haze in mental health is so huge, most parents will never get to researching of the kind my mother could read or comprehend, or what most other researchers access and read, especially in the context of critical psychiatry and psychology. I even work in language to see how language impacts mental health- and what are the complexities of the phenomenon.
Recovery is Coming into Light
In some advanced countries of the world, as I noted earlier in this article, recovery has become an important focus for caregivers. But these are welfare oriented countries, not where health care spending is routinely cut to add to defense budgets or give bailouts to big industrial houses.
Recovery is only going to be a focus in cases where people are not worried about making profits out of healthcare. Yesterday a senior and retired professor of Psychiatry sent me some of his writings, in which he is talking of the utility of home based care in which a caregiver who is a trained professional would go to people’s homes and offer guidance and support not only to the main ‘patient’ but also their family caregivers. This is also the sort of model which has been followed in Finland, where they have accomplished recovery to such an extent that they have practically emptied out psychiatric wards in hospitals. Their model of social psychiatric, services embedded within the community, is taken as an exceptional model by all standards.
However, to make that model a reality one would have to create the sort of social, cultural, political, and financial infrastructure that Finland created for it to succeed. As of course the willpower that we wanted our people to recover. Do we really? Who has the jobs to offer if more people join the workforce, if they want to be married and want housing, if they want everything the way everyone else does? Who wants that psychiatric medicines should be consumed and psychiatric wards should remain active and abuzz with human footfalls? Surely not parents or caregivers.
So whose focus should it be that their children and loved ones should become well? Those whose interests are tied to the perpetuation of psychiatry? Will parents wake up and see reality?
Will they understand that they do not need to fight for more psychiatric services, but better education systems, and health care (not mental healthcare)?
Will people ever understand which wolf is wearing the sheep’s clothing?
On a parting note, in case any parents are reading this, please work with those psychiatrists who are employed in government hospitals, not private clinics, because they would be glad to assist your children/loved ones be on the lowest possible dosage of drugs, and not prescribe unnecessary tests, unless absolutely required. They are the most likely people who would have a recovery focus. Meeting some psychiatrists I too have gained that impression. All of them are not feeding the pharma-industrial complex alone- some genuinely care for patients.