7 years ago, while studying Psychology in college, I decided to shadow a Psychiatrist, to get a better grasp of clinical psychology in practice. This wish was busted after my first day in his office. Within 5 minutes of my walking in, he told me he would write me an internship letter without my having to come to his office at all – a certificate in genuine good will (Aren’t you jealous?) His explanation was interrupted by the entry of a first-time patient- an elderly man. The visit could not have lasted more than 10 minutes (which included the doctor excusing himself in between for some urgent work). During that time, the man explained that he had been “feeling low” for a few weeks. He tried to elaborate a little on this feeling, but he didn’t need to. The doctor had already diagnosed him and was quickly filling out a prescription page in his sure long handwriting.
“It’s depression,” he told him and asked him to collect the medicine from the chemist in the hospital.
This was one of the better-known hospitals in the National Capital Region of India. And I sat in shocked silence.
I was young and shy and did not have the courage to argue with the more experienced looking doctor in front of me, but I was deeply concerned. Even with my inexperience, I knew how devastating such a rash diagnosis could be. This was in stark contrast to the instruction I was receiving in college about the need to be careful when diagnosing mental illness, the deep analysis involved in such a diagnosis, and the severe harm that misdiagnosis can have on the physical and psychological well-being of the person.
Doc aided Pill Popping
Over the last few years, I have heard about friends, family, and acquaintances being prescribed mild anti-depressants by general physicians. Some of them continue to purchase and use these medicines beyond the specified period. Chemists in many Indian pharmacies seem to be satisfied by an official looking prescription, irrespective of the date or validity of said prescription. While chemists do tend to be careful about giving sleeping pills and mood altering pills to youngsters, fearing suicide attempts; they are not so careful when giving them to middle-aged buyers. I have been questioned by chemists while trying to buy mild sleeping pills that my father has been purchasing for years from the same chemists. Some of these pills are given over the counter without the need for any prescription at all.
For example, “Alprazolam” the mild benzodiazepine, is handed out quite casually in India. But here’s the thing, abusing of these pills goes beyond just suicide attempts. While single doses of these pills are harmless, repeated use of them over a long period without medical supervision can be extremely harmful.
Although it is harmful to all people, it can be especially destructive for those with existing undiagnosed (or misdiagnosed) mental health conditions. There are many psychiatric illnesses with similar or overlapping symptoms. For instance, anxiety disorder and depression show certain similar looking symptoms, but they both need different diagnoses and treatments. Same goes for bipolar disorder- this disorder shows both depressive and manic symptoms, and more often than not people approach a doctor when they are experiencing depressive symptoms. In such a case if a physician, like the one I tried to intern with, hurriedly diagnoses and medicates with anti-depressants, this misdiagnoses may aggravate the symptoms, even result in psychosis. According to a recent study by Journal of Clinical Psychiatry, less than half of those who were previously diagnosed with bipolar disorder met the clinical criteria for the illness (Zimmerman and others, 2008)
Disregard for the Root Cause
Another concern is the prescription of medication in the absence of therapy. Recent numbers show that 57% of patients receive medication without psychotherapy in the United States. These numbers will likely be much higher in India. Despite the recent trend of lip-syncing mental health awareness in Indian urban centers, there is still painfully low awareness on the need for good psychotherapy. Instead, medications are given to suppress psychiatric illness and symptoms in the absence of psychotherapy. Even when counseling is available, finding quality counseling centers or psychologists is a hit-and-miss chance. Due to the stigma associated with mental illness, and the absence of health insurance covers for psychotherapy sessions, most people are unwilling to undergo an extended, expensive treatment process. But medicating the symptoms without acknowledging the underlying cause of the symptoms is a short-term cure at best, leading to repeated resurfacing of the same symptoms. Imagine this scenario: a person due to severe under-nutrition shows symptoms of skin dermatitis and de-pigmentation. When the person is brought to the attention of medical personnel, they naturally want to treat the skin disorder and give her/ him the required medication for it. But if they give the medicine without the food and nutrition intake that the person is in urgent need of, all they’ll be doing is treating the symptom without addressing the underlying cause- that is, severe under-nutrition.
After closely witnessing people being irreparably harmed due to such careless misdiagnosis, excessive medication, and inadequate rehabilitative support, I am extremely troubled by this trend. Over-medication, brought about by the lobbying and bribery of big drug companies, is something we are witnessing across the globe. And while some of us might be aware of it, when a doctor with 10+ years of experience writes down a prescription for us, very few of us have the courage to risk disobeying it.
I am not propagating disregard for medical knowledge. All I am arguing for is showing more caution, on the part of the doctor, the patient, and the chemist, when it comes to consuming psychoactive drugs, especially the more benign-seeming anti-depressants, and sleeping pills, that we tend to pop without much deliberation.