An article recently published in the New York Times, Drowned in a Stream of Prescriptions, raises some important points on which Mental Health professionals and clients alike should reflect. In the field of Mental Health, diagnosis is notoriously difficult. Studies indicate that if a group of psychiatrists or psychologists are given the same information about a client’s presentation the rate of consensus on diagnosis is quite low. In many cases this isn’t a big problem: differences in diagnosis can often have relatively small implications for treatment. In other cases, however, the consequences can be catastrophic: The Coroner’s Court of New South Wales concluded that the suicide of channel 10 news reader Charmaine Dragun may have been prevented if she had been diagnosed and correctly treated for Bipolar Affective Disorder Type II instead of depression. Confirming the challenges of diagnosis, in my own reading of the inquiry on her case (admittedly with less information available to me than was to the inquiry) I find it difficult to imagine I would have made a Bipolar diagnosis, and still wonder if the underlying risks were due to another condition not considered by the inquiry.
Accurate diagnosis is difficult enough when professionals are basing decisions on accurate information. However, the above New York Times article tells the story of a promising young student, Richard Fee, who was able to mislead treating professionals into making a diagnosis of ADHD in order to maintain access to stimulant medications prescribed for its treatment. He was using these medications to help him study. His misuse of the drugs led to psychosis and, finally, suicide.
For Mental Health professionals, it is important to keep in mind the potential risks of making any diagnosis. Even if you are not the one prescribing medication, diagnoses have a tendency to stick. It is also important to learn from Richard Fee’s case that family should be listened to. While ethics and privacy laws prohibit disclosing information to family without the consent of a client, they do not prohibit listening to family expressing their concerns. In Richard’s case that could have been life saving.
It is also important that Mental Health professionals abandon the notion of psychotropic medications are harmless. This idea, which emerging research is thoroughly debunking across the entire range of psychotropic drugs, continues to have a hold among professionals:
“If you misdiagnose it and you give somebody medication, it’s not going to do anything for them,” Dr. Katz concluded. “Why would they continue to take it?”
The reality is that medications that alter brain chemistry are not a good thing for people whose brain chemistry does not need altering. And even for those who do need treatment, the risks may sometimes outweigh the benefits (Antidepressants may not be worth the risks, researchers say).
For clients, it is important to keep in mind that diagnosis is a challenging business, and to be willing to seek second (or third and fourth) opinions if treatment is not producing the expected results. Do not make the same mistaken assumption as Richard Fee:
“The doctor wouldn’t give me anything that’s bad for me,” Mr. Fee recalled his son saying that day. “I’m not buying it on the street corner.”
Diagnose with caution.