[warning: this is a critical blog post about psychiatric diagnoses and drug prescribing]
I've been reading through the SIGN (Scottish Intercollegiate Guidelines Network) guidelines on Schizophrenia (131) March 2013 and Bipolar Affective Disorder (82) May 2005. I notice there is also a link from number 131 on SZ to "Management of Perinatal Mood Disorders" March 2012, number 27. (pick a number)
What bothers me about psychiatric diagnoses/labels is their subjectivity and what amounts to a stab in the dark as to what is "wrong" with a person who ends up a psychiatric patient. I've known many people who have started off with one diagnosis and ended up with another or have gone through many of the disorder labels in the course of their "mental illness".
The one constant on their journey is the drug prescribing, from antipsychotics to antidepressants via "mood stabilisers" and benzodiazepines. Polypharmacy as a means of control and "management" of symptoms. Heaping drug upon drug to deal with side effects until a person doesn't know if they are coming or going. Which is how I eventually felt on Risperidone, Venlafaxine and Lithium in 2002/3. Experiencing anxiety attacks and having to take the occasional Lorazepam, an addictive benzo.
I use the inverted commas to signify psychiatric language which has a double meaning. For example: management of symptoms equals controlling behaviour; mood stabiliser equals controlling behaviour and antipsychotic side effects; mental illness equates to having a mental health issue which the drugs don't cure and often exacerbate, causing debilitating side effects and long term chronicity.
I'm not a fan of drugs, of any sort. Regardless of them being called "medication". When we were children, in my generation, 1950's, we had to hold our noses to swallow medicine in liquid form. It tasted horrible. So did the cod liver oil. Although the malt extract wasn't so bad. We cried when getting the polio injections and eventually the drug went into sugar cubes.
I remember queuing up at Perth Academy to get the BCG in a jag, aged about 13. A vaccine against Tuberculosis. Some pupils fainted, a few had the misfortune of the needle breaking in their arm. Others of us just took a deep breath, got it over with. However I never got the Smallpox vaccination when a baby in the early 1950's which left a scar on the upper arm. I assume because my father didn't want me to have it, the risk of adverse side effects.
My father didn't follow the crowd, was ahead of the game. One of a kind, he did things in a big way, like setting up fireworks displays for the community where we lived near the rail station in Perth, Scotland. Or getting us ringside seats at Billy Smart's Circus and meeting Coco the Clown. A sartorial dresser with handmade suits, cravats, waistcoats, bow ties. Listening to German opera on the record player which meant we couldn't get to watch the TV.
I'm glad to have inherited my father's independent thinking. It's stood me in good stead when it came to engaging with psychiatry and being forced to conform and swallow the medicine. In the early days they had to hold me down and forcibly inject the Chlorpromazine into my rear end when I wouldn't be persuaded to take the pill. When voluntary patient meant nothing of the kind. Nowadays they use the Mental Health Act to coerce and control.
It's got worse. The proliferation of psychiatric drugs, polypharmacy, cocktails of antipsychotics, antidepressants, mood stabilisers and benzos. None of them any better than the ones that came before. More difficult to taper and get off even if the side effects initially feel less severe. Conning a person into a drug regime and sticky labels.