Be careful of how you phrase it:

Dear Dr. Brilliant Cliché,

I am a therapist and this “medicate everything” model that is prevalent today drives me nuts. Everybody is on some prescription because everybody has some sort of symptom and that is all you need in order to be medicated. In school they called it the bug and drug approach to medicine.

I write today because I have a client who is a living example of this inability to escape the expectation of symptoms and medicating them. She has a normal IQ but is very concrete in her thinking. She is completely and utterly literal in her interpretation of language. She also believes literally everything she reads and if she has an ache, or pain, or uncomfortable emotion, she spends her day on the internet researching medical sites. She then goes to her doctors and announce: “I have spina bifida.” It would not occur to her to simply say “My back hurts,” and wait for an opinion.

She has been on tons of medication and in numerous psychiatric hospitals. Nothing has made the slightest difference except that she is coming to resemble a zombie.

Today I sat with her and we had a discussion about how she phrases things. By now I feel I know her well enough to believe that she isn’t hearing voices, any more than anyone else hears their inner voice. But being literal and being raised around the bible she interprets her thoughts as “Satan talks to me.” When pressed, she eventually arrives at concrete and fairly workable notions: “Do good for others,” and “Be kind.” But it is an arduous task to get her to come to the point. Socially, she has no concept how people are receiving her and people have NO idea what she is talking about.

Just today, she decided that a disc in her back had slipped and she would most certainly be paralyzed for life. In truth, the symptoms were probably just side effects from the thorazine and haldol given to her. Her doctors continue to medicate her symptoms and no one ever asks “WHY is she feeling this way?”

Her only real problem is probably receptive and expressive learning disorder.

Unfortunately her scenario is not uncommon.

Frustrated Provider

Dear Frustrated,

I feel for your client. In our medical system, you have to “get” some disease or dysfunction in order to go to a provider. This is the expectation of both the client and the doctor. Now that insurance companies limit doctor’s time, the big picture is bypassed in favor of symptom clusters, diagnosed disorders and medication. It takes a too much time and patience for a doctor to really see the big picture with any client. Insurance won’t allow for it.

If people knew what they really needed, and why, they wouldn’t go to therapists in the first place. Most people confuse what they want with what they need. The two are not often in sync. Your client knows what she wants, but has neither the education or understanding to know what she really needs. Learning new skills would probably help her far more than any medication.

A doctor and client need to reach a cooperative relationship. A client needs to advocate for themselves but at the same time a doctor should not be afraid to say “that might not be in your best interest.” Many doctors enable their patient’s misinformed habits. Medicine is an art but insurance doesn’t cover artistry, it just covers the diagnosis and the pills.

It is good you are working to teach your client to be a better advocate for herself. There are also professional patient advocates if needed.

Dr. Brilliant Cliché

Granny says: I honestly blame capitalism for our current medical model. I spend a good part of my year in Taiwan, a country where the health system is set up as social medicine. People pay very little for their health care. No one can make money off of their continued dependence on the system, so there is more of a desire to re-construct people properly then send them on their way to be productive workers; the work ethic is very high here as well. In our country, the more dependent a patient is upon their doctor for continued prescriptions, repeated treatments, and crisis care, the better. Everybody gets their cut.

I spoke with a podiatrist who had traveled to Togo in Africa as part of a medical team. He is angry about the waste in this country. He told me that an insurance company will pay out a total of $5,000 for surgery every year to correct a recurring foot ailment that could be better alleviated with special shoes to correct the actual problem. The shoes would cost about $250, but the insurance company won’t cover them. Patients can’t afford the shoes so they get the free operation. Do the math on this and you will understand why health costs in this country are out of control and mental health problems and chronic disorders are still multiplying by the year.

I have absolutely no advice for you. You can’t change the system. You can only change what you do in your own office. If you have the guts to advocate in your local congress, you would be a huge help to the naturopathic physicians and other healers who are trying to help people through integrative health care.

Good luck.

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About Dr. Brilliant Cliché

Dr. Brilliant Cliché and the Granny Dr. are a fictional web presence and advice blog. Together we offer a joint perspective that is deep but not academic, entertaining but not fluff, and educated yet street smart. By joining the internet community we hope to share thoughts and stimulate insightful conversation around pressing issues that affect us all. Looking forward to hearing your thoughts. (This is not a site for therapy nor does it intend to replace medical or other professional care. ) You can leave comments here or email The Dr. at dr.brilliantcliche@yahoo.com and don’t forget to like us on facebook. Our facebook page is Dr. Brilliant Cliche
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2 Responses to Be careful of how you phrase it:

  1. Margaret says:

    Do you think it possible this woman may have a high functioning Autistic condition. Aspergers perhaps? If so, all the potent medication she’s given will be making things worse. She could end up diagnosed as seriously mentally unwell. Treatment Resistant Schizophrenia is one example of a case I know of. Decades of absolute torture on high doses of neuroleptics nearly killed this person more than once.

  2. Dear Margret,
    Yes Asperger’s is on the expressive and non verbal spectrum. And yes There are no medications for it and as speech and language disorders are not on most doctor’s radar they tend to get medicated a lot for no particular good end. This occurs in many other situations also as we live in a bug and drug medical culture. I cant tell you how many times I’ve seen mentally retarded individuals put on Adderall for adhd as they have poor attention spans. Then they get put on other medications for aggression which in reality the Adderall caused. No one seems to realize that below a 74 IQ can come with a short attention span and not all lack of attention is ADHD. But every lack of attention will test (+) for adhd no matter what the cause.

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