I watched Requiem for a Dream (2000) over the weekend. It’s a sad, sad story about addiction, loneliness, and the impossibility of some to deal with feelings. Ellen Burstyn plays the mother of a heroin addict. She herself lives alone and is, I guess, dying of loneliness.

While I “appreciate” addiction – I get it, I’ve seen it, it’s awful, mostly an illness – but somewhere along the line I believe it’s a choice, usually of how one copes with feelings and anxiety. What I saw happen to Ellen’s character is not so much a choice - sort of. She comes from a time and culture that puts a lot of value in what a doctor says and believes. They are the professionals, what they say must be right, must be good for the patient. She gets her “drugs” prescribed to her. She becomes addicted to diet pills, and then God knows what else is prescribed in a bid to help her cope with the "side effects" (read addiction to speed).  By the movie’s sad end, she has become anorexic, psychotic, is shackled, force fed, and finally given electric shock treatment – which renders her a vegetable.

I have had so many clients come into my practice that have been prescribed medication – for depression and/or anxiety – by a GP, with no request for follow up by a mental health professional. Personally I find this unbelievable. In my training I learned (maybe wrongly, but I don’t think so) that depression usually has a predictable course, that it doesn’t last forever, and even WITHOUT medication it often resolves itself within six months to a year. I learned that medication is a SHORT-TERM solution that is intended to help “lift” the individual enough to be able to do the work one might do in therapy, to help them cope and work on resolving the depression or anxiety all together.

But that’s not what I am seeing. People are being put on medication, like Effexor, Paxil, Celexa, Prozac, Cloazepam, for years. Years! without EVER having seen a mental health professional! I have seen people being put on several different medications, to alleviate depression and to help them sleep all at the same time .. again for years. It is my belief that the end result of being on something for so long is that the brain loses the natural ability to create the neurotransmitters/hormones required to do this “work” itself. Sometimes the brain stops producing the required serotonin for example all together – why bother it says, a pill to do it for me is on the way!

I realize there are times when medication is in fact useful. Sometimes we find ourselves suffering too much and we have to take advantage of medication, not doing so would be "causing harm". However there needs to be a balance doesn’t there? There needs to be follow up, accountability, and assessment as to the outcome of taking something for so long.

A piece of the movie was very disturbing and that was the part of the doctor never even looking at the patient. He would look at the file in his hand and decide what needed to be done without ever looking at the person. I actually had a doctor like that once. He refused to answer my question, just out right refused, and then stopped acknowledging me all together. I was dumbfounded and didn’t know how to respond. That’s unacceptable behaviour.

The medical profession might do well to consider the whole person, in the context of all the resources available to them in terms of coping.  I would say the same to any mental health professional – do not get the notion that you are the only support available to a client. And if you are, then it behooves us professionals to help those clients expand their network of support. We can model that for them by speaking to each other - doctor and psychologist, doctor and therapist, doctor and social worker. Individually, we are but a small slice of their life and all clients SHOULD have a far greater network than just one therapist, or just one doctor and certainly more than just a bottle of pills.

Come on helpers, we can do a whole lot better.

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