Pill Pushers versus Dedicated Doctors

Mike’s first breakdown happened in 2001 and since then he has been seen by nine different psychiatrists – some private, some in emergency rooms, some in community treatment programs. As best as I can tell, only two of them – that’s right two of them – have bothered to learn anything more about him than his name and symptoms.
I remember confronting one of Mike’s first doctors when I realized that he had only spent ten minutes talking to my son and had no family or medical history to review. The psychiatrist explained that he didn’t need to know any of Mike’s past information, only the names of medications that Mike had and was taking.  He explained that his job was to render a correct  diagnosis and then prescribe the appropriate medication. After that, it was up to a social worker to deal with Mike.
I was frustrated and angry.
I thought Mike would be seeing the psychiatrist for regular couch sessions, just like on the old Bob Newhart Show (Wow, am I dating myself here!)  But while the so called “worried well” might be invited to explain their troubles to a note-taking psychiatrist during talk therapy, Mike was being shown the door.
There were many reasons for this. Bipolar Disorder is considered an organic, chemical imbalance by many doctors so medication is seen as the main solution. There is no need to get to know a patient, especially when insurance companies are only willing to pay for a fifteen minute check on medications.
I’ve always argued that treating the mind also requires treating the heart – the whole person.
Which is why I admire psychiatrists such as Dr. Tracey Skale, who works for the Greater Cincinnati Behavior Health Services and is one of the panelists featured on Minds on the Edge – the PBS program that I wrote about on Monday.Dr Tracey Skale describes the
Those of us who know Dr. Skale marvel at her boundless enthusiasm. She is a non-stop beam of hope for her patients and their families. One of the best examples of her dedication is a patient named Rick, who had been homeless for more than 21 years. Severely ill, Rick fell into that “frequent flyer” category of  chronic homelessness — men who are considered by some to be “un-restorable” and so sick that they must be housed in an institution. That’s not how Dr. Skale saw him.
You can watch a video that tells Rick’s story by visiting:
It is well worth your time.   You also can see segments at that same link that feature Dr. Skale being interviewed.
After one of our joint appearances together to promote Minds on the Edge, I wrote Dr. Skale an email and mentioned how much I admired her dedication.  Her response speaks volumes about the difference between a psychiatrist, who has let himself be turned into a pill-pusher, and someone who makes a difference in a patient’s life.
“I am convinced that relationships are the key to recovery,” Dr. Skale wrote. “Warmth, dignity, respect are all vital to alliance-building. When the person in front of me believes that I believe in him and that he has the right to have a meaningful and fulfilling life , that goes an incredibly long way.”

I get up every morning and thank God for the case worker who is overseeing Mike’s recovery. She and medical professionals such as Dr. Skale are changing lives.
About the author:

Pete Earley is the bestselling author of such books as The Hot House and Crazy. When he is not spending time with his family, he tours the globe advocating for mental health reform.

Learn more about Pete.

  • Maria Lissintoome

    Pete,

    The correct name for pill pushing in “medication management”. If you also take note the Medication Managers, who at one point in their life went to medical school, usually do not monitor blood pressure, weight, sugar levels, etc. all of which could be effected by the medications they are managing.

    Perhaps if the Medication Managers spent more time with their patients they could figure out the underlying cause of their illness was related to a disease.

  • Maria Lissintoome

    Pete,

    The correct name for pill pushing in “medication management”. If you also take note the Medication Managers, who at one point in their life went to medical school, usually do not monitor blood pressure, weight, sugar levels, etc. all of which could be effected by the medications they are managing.

    Perhaps if the Medication Managers spent more time with their patients they could figure out the underlying cause of their illness was related to a disease.

  • Maria Lissintoome

    Here is an interesting case in the news:

    http://www.boston.com/news/local/breaking_news/2010/01/_brockton_-_tes.html

    “Carolyn Riley brought her older daughter, Kaitlynne, then 2, to see Kifuji who was then practicing at a clinic a Bay State Medical Center in Springfield.
    After a one-hour meeting in her office, the psychiatrist diagnosed Kaitlynne as having bipolar illness and immediately prescribed Depakote based largely on the mother’s depiction of the girl as physically aggressive to her older brother, and the girl saying she sometimes saw “monsters” and “ghosts.”

  • Maria Lissintoome

    Here is an interesting case in the news:

    http://www.boston.com/news/local/breaking_news/2010/01/_brockton_-_tes.html

    “Carolyn Riley brought her older daughter, Kaitlynne, then 2, to see Kifuji who was then practicing at a clinic a Bay State Medical Center in Springfield.
    After a one-hour meeting in her office, the psychiatrist diagnosed Kaitlynne as having bipolar illness and immediately prescribed Depakote based largely on the mother’s depiction of the girl as physically aggressive to her older brother, and the girl saying she sometimes saw “monsters” and “ghosts.”

  • Pam

    Hi Pete,
    Brought to your blog from a link posted on the Minds on the Edge Facebook page. Enjoying the posts, and will be reading more :)

    I have bookmarked it, but wish you had one of the “Follow” widgets on the blog, which allow others follow easier and keep up to date when new entries are available. The widgets are available from many sources – Networked Blogs on Facebook, Blogger, or other blog directory sites… If its something you’d consider, perhaps your son will add one for you :) Those of us who “follow” would appreciate.

    Great blog, thanks

  • Pam

    Hi Pete,
    Brought to your blog from a link posted on the Minds on the Edge Facebook page. Enjoying the posts, and will be reading more :)

    I have bookmarked it, but wish you had one of the “Follow” widgets on the blog, which allow others follow easier and keep up to date when new entries are available. The widgets are available from many sources – Networked Blogs on Facebook, Blogger, or other blog directory sites… If its something you’d consider, perhaps your son will add one for you :) Those of us who “follow” would appreciate.

    Great blog, thanks

  • CarolAnn :)

    My son was diagnosed with BPI w/psychosis when he was nine. This was no surprise to me since my family is rife with manic depressives and schizophrenics.

    It took some doing, especially since this was 1997, when Dr. Papolos’ book had just come out and doctors were still arguing about the diagnosis of BP in children.

    I didn’t have support groups, ongoing research (my son was in some of the first research trials), or websites to help me through this.

    What I had was my own long diagnosed manic depression, personal knowledge, a stubborn streak a mile wide and a love for my child that wouldn’t let me quit – and a lot of lithium (for me).

    Everything that was out there was for adults. I already knew how to treat my own mania – I needed to know how to treat a puberty-age boy who saw things coming out of the wall to kill him on a regular basis.

    We went through at least 10 psychiatrists before I found one I trusted to treat my son, I don’t know how many therapists until I found one who took the time to understand and learn with my son, and three moves to get to a school district that had the resources to help my son. I also gave up my education and went back to work to get the money and insurance to pay for all this.

    13 years later, my son is in pretty good shape. The psychosis faded with puberty and he is able to hold a job and go to school. He manages his illness himself. He’s a good kid – a little flighty and a little prone to go off in the multitude of directions to follow his dreams, but a good kid who will survive.

    All the pain was worth it to see him smile.

  • CarolAnn :)

    My son was diagnosed with BPI w/psychosis when he was nine. This was no surprise to me since my family is rife with manic depressives and schizophrenics.

    It took some doing, especially since this was 1997, when Dr. Papolos’ book had just come out and doctors were still arguing about the diagnosis of BP in children.

    I didn’t have support groups, ongoing research (my son was in some of the first research trials), or websites to help me through this.

    What I had was my own long diagnosed manic depression, personal knowledge, a stubborn streak a mile wide and a love for my child that wouldn’t let me quit – and a lot of lithium (for me).

    Everything that was out there was for adults. I already knew how to treat my own mania – I needed to know how to treat a puberty-age boy who saw things coming out of the wall to kill him on a regular basis.

    We went through at least 10 psychiatrists before I found one I trusted to treat my son, I don’t know how many therapists until I found one who took the time to understand and learn with my son, and three moves to get to a school district that had the resources to help my son. I also gave up my education and went back to work to get the money and insurance to pay for all this.

    13 years later, my son is in pretty good shape. The psychosis faded with puberty and he is able to hold a job and go to school. He manages his illness himself. He’s a good kid – a little flighty and a little prone to go off in the multitude of directions to follow his dreams, but a good kid who will survive.

    All the pain was worth it to see him smile.

  • Tracey Skale

    Pete — Thank you for your kind words about the work that we do at our agency. I will never forget hearing you say that after a lengthy wait in an ER with your son, the doctor told you, “we can’t help you Mr. Earley…” That sent chills through me. I can’t imagine how desperate and helpless you must have felt at that time. I try to be in the moment with each person I see. Respect and warmth and dignity — those are the key elements of my relationships with my patients. I am touched every day by how the simplest act of kindness is so greatly appreciated by the people I have the opportunity to meet. I never forget that each person I see is someone’s child, someone’s brother, someone’s parent. My favorite thing to say is something like, “I’m so sorry you are having such a difficult time….. we can help you…. and we will be with you every step of the way.” Medications are helpful to many people but that is not the only answer. We try to establish a trusting relationship. We focus on strengths and how to get the individual moving forward in life. Housing First is extremely helpful to us. We also recommend NAMI for families and strongly encourage family involvement with us if the patient is fortunate enough to have family support.
    Thank you for your advocacy and ongoing support. You are a true champion of hope.

  • Tracey Skale

    Pete — Thank you for your kind words about the work that we do at our agency. I will never forget hearing you say that after a lengthy wait in an ER with your son, the doctor told you, “we can’t help you Mr. Earley…” That sent chills through me. I can’t imagine how desperate and helpless you must have felt at that time. I try to be in the moment with each person I see. Respect and warmth and dignity — those are the key elements of my relationships with my patients. I am touched every day by how the simplest act of kindness is so greatly appreciated by the people I have the opportunity to meet. I never forget that each person I see is someone’s child, someone’s brother, someone’s parent. My favorite thing to say is something like, “I’m so sorry you are having such a difficult time….. we can help you…. and we will be with you every step of the way.” Medications are helpful to many people but that is not the only answer. We try to establish a trusting relationship. We focus on strengths and how to get the individual moving forward in life. Housing First is extremely helpful to us. We also recommend NAMI for families and strongly encourage family involvement with us if the patient is fortunate enough to have family support.
    Thank you for your advocacy and ongoing support. You are a true champion of hope.

  • Kathy

    Hello,
    Both my son who's 26 (2 genreaton of family history of Bi-polar) and my best friend's daughter 24 are experiencing full blown mania. (1 in million this is possible for us as best friends since high school) Her daughter went W/o sleep for 12 days before calling her parents for help. She was admitted for a week.
    We are looking for tools for parents to be their safe network to helping our adult children and family/friends who are very uncomfortable with the sudden changes. My son to spending large sums of money, not sure where it's all coming from. Has made a quick decision to get married in two weeks @ courthouse, he's on a role.
    She is not buying into the system that pushing RX's down your throat
    which is overdosing her to the point she is not functioning well. They are both exhausting everyone to the point no one wants to be around them. I have watch the PBS video. I'm trying to look for resources from you that can help us. We want to be their advocates and form a support/coping group among our immediate family and closet friends. Both of them are extremely bright!! Then all hell broke lose. We as mother's want to try different measues than struggling and pressuring them into the medical system.
    In others word seeking a family-care system, that can impower all of us to gain more education and daily support no matter who happens to be in their life that day. We just can't sit around unitl something terrible goes wrong. Thank you for commitment to this cause.
    Sincerely..Kathy

  • 19umbrella57

    Hello,
    Both my son who's 26 (2 generations of family history of Bi-polar) and my best friend's daughter 24 are experiencing full blown mania. (1 in million this is possible for us as best friends since high school) We think both were trigger by going off anti-depressants by themsleves w/o DR's help. Then all hell broke lose.
    Her daughter went w/o sleep for 12 days before calling her parents for help. She was admitted for a week.
    She is not buying into the system that pushing RX's down your throat
    which were overdosing her to the point she is not functioning well.
    We are looking for tools for parents to be their safe network to helping our adult children and family/friends who are very uncomfortable with the sudden changes.
    My son is spending large sums of money, not sure where it's all coming from. Has made a quick decision to get married in two weeks @ courthouse, he's on a role. Highly agitated as the weeks go.Overpowering conversations, daily schedule changes and delays. Sent a threatening email to a family member who he dislikes deeply.
    They are both exhausting everyone to the point no one wants to be around them. I have watched the PBS video. I'm trying to look for resources from you that can help us. We want to be their advocates and form a support/coping group among our immediate family and closest friends. Both of them are extremely bright!! . We as mother's want to try different measues than struggling and pressuring them into the medical system.
    In other words seeking a family-care system, that can empower all of us to gain more education and daily support no matter who happens to be in their life that day. We just can't sit around unitl something terrible goes wrong. Thank you for commitment to this disorder.
    Sincerely..Kathy

  • HI,

    Its very interesting post guys.

    I liked this post.

    Thanks