Opinion: Psychiatry

POSTED: 03/16/12 2:40 PM

The notion that psychiatric patients are a pain and that it is therefore best to ignore them as much as possible is a false one. Psychiatric and psychological disorders are on the rise and it seems that our community is ill-prepared for this situation. Of course we have the Mental Health Foundation that is doing wonderful and absolute necessary work. We also have a rehab facility at Turning Point; that’s good as well: quite often addiction and psychiatric or psychological disorders go hand in hand.
The question is whether we are doing enough as a community for these citizens. This is, on the government-level, a matter of priorities. Do we use our money to build a causeway over the lagoon or do we use these funds to improve this rather critical element in our healthcare system? We all know by now that the causeway is deemed more important. It’s a fact of life we will have to deal with and the real world will make sure that we will get to deal with the consequences of such choices.
People who suffer from a psychiatric or psychological disorder may do at times crazy things. They may become a danger to themselves and to their environment – and that includes family members. When these things happen, patients may become suspects in a criminal investigation. They are locked up, taken to court, and maybe sent to prison.
Everybody knows that this is not a solution: psychiatric patients do not belong in prison; they belong in a mental care institution. Our Mental Health Foundation is able to do only that much.
There is however a private sector party with a more than healthy interest in people with psychiatric and psychological disorders and that is the pharmaceutical industry. The producers of all those nifty pills to keep mental patients in check turn out to have an ever increasing influence on practitioners in the healthcare sector – psychologists and psychiatrists.
The Diagnostic and Statistical Manual of Mental Disorders, commonly referred to as DSM, is the Bible for psychiatry. In May of next year DSM-5 will be published.
American researchers have found that more than two third of the psychiatrists and psychologists who determine the content of DSM-5 have ties with the pharmaceutical industry.
Experts from different countries have been working for years on the content of DSM-5. They do this in committees that take decisions about groups of disorders.
The researchers found that the most ties with the pharmaceutical industry are among committee-members who study disorders for which the first treatment option is medication. They mention the committee that deal with sleeping disorders as an example. All seven committee members have ties with the pharmaceutical industry.
And there is more: the committee has proposed to add restless legs as a new syndrome to DSM-5. The researchers note that there is medication on the market for this disorder.
DSM-5 will have a significant influence on diagnoses and treatments. The medical professionals that write the guidelines must therefore be judged strictly on their independence, the researchers note.
Internationally criticism of DSM-5 is increasing. The critics point to a number of new diagnoses and say that there is a trend to medicalize normal behavior. There are for instance attempts to categorize as depressed people who mourn for a long period of time over a lost loved one.
The same researchers investigated a couple of years ago the conflicts of interest between the pharmaceutical industry and the compilers of the previous DSM-edition. They found then that 57 percent had ties with the industry.
The American Association for Psychiatry decided to make the interests of all members public. That attempt at transparency did not help, the researchers say, because the number of experts with ties to the industry increased by 20 percent.
The researchers note that this is a dangerous trend, because ties with the industry easily influence the way experts think. Medicine studies that are financed by the pharmaceutical industry bring more often positive results than studies that are not sponsored.
But a professor in pharmaceutical medicine in Nijmegen – Henk Jan Out – told the Volkskrant this week that it is near impossible to find experts who have never worked for the pharmaceutical industry. That does not make them necessarily unreliable, he said. “They are consulted by the industry because they are experts. Independence could potentially become synonymous with less know how, and therefore with less quality.”
It looks like the people who are depending on these experts – the patients – are caught between a rock and a hard place. Especially in psychiatry medication is often used as a way to bring undesirable behavior under control. If it works – fine, at least up to a point.
The tendency to medicate often leaves other options unexplored. Medicating could very well be the best solution for society (in the sense that unwanted behavior is brought under control), but it is not necessarily the best solution for the patient who is without medication quickly back at square one.
However, all these consideration should not get in the way of the number one priority and that is that citizens in St. Maarten with psychiatric and psychological disorders need help and care before they are thrown into the treadmill of the criminal justice system.

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