I really should be packing for a conference, not figuring out more stuff to blog about, but I saw an item in today's Boston Globe that I just couldn't resist, because it speaks so closely to what we're talking about on this blog. A woman pediatrician wrote an OpEd piece, in part, about the insufficiency of the strictly pharmacological solution for healing a broken childhood.
In our case, since we're talking about combat trauma, the target is different, but the concept is identical. Read what she has to say, and then think of the ways this applies to healing combat trauma. Far too many health care providers -- and even veterans and their families -- are putting their faith exclusively in a pharmaceutical solution. It isn't a Tom Cruise point to say, that's not really going to do the whole job.
As we've seen and heard from too many veterans, the trouble with pharmaceuticals alone are many and varied...from giving veterans a grab bag of ones to mix and match and medicate themselves (yikes)...to the dangers of over-medicating (numbing out, not feeling like themselves) and under-medicating (well, that hardly ever happens, but still...) Anyway...here's the pediatrician's extended commentary. Make the application to veterans suffering from combat trauma and you'll see what we mean:
On one recent day in my pediatric practice, I saw or spoke with parents of eight children who had experienced a range of significant trauma. One was in foster care after living on the streets with drug-abusing parents. Some had been adopted following severe abuse and neglect. One had recently lost a parent to death, one had been abandoned by a parent. They were failing in school, impulsive, distracted, angry, and depressed. They were receiving minimal to no mental health support.
When I suggested that medication alone was not the solution, I ran into walls. One mother had tried to get an appointment with a child psychiatrist, but the only one in town who accepted her insurance wasn't taking any new patients. My attempts to refer families for therapy were thwarted by many things, including lack of time and clinicians who did not take their insurance. One parent was irate that I asked so many questions and didn't just refill the prescription. These parents were discouraged and angry, and by the end of the day, so was I.
Our society has bought into a belief that manipulating medications will fix these complex problems. Not only parents, but teachers, physicians, and certainly the health insurance and pharmaceutical industries join in promoting this expectation. With our overreliance on psychoactive medication, we have created another Ponzi scheme where, just as Bernard Madoff's investment fund was not really earning any money, we are fooling ourselves into thinking that we are helping these children in any significant way.
Interesting and poignant, on so many levels. The expectation, impatience and frustration of the patients' families, that manipulating the patients' biochemistry was the only "solution" expected or desired; the practitioner's frustration that she couldn't refer effectively to other providers who might have helped; and the generalized problem with only seeing a headache as an Excedrin deficit, so to speak, rather than looking for the broader understanding of what's sometimes at work with a specific symptom.
Fortunately there are complementary and alternative medicine ("CAM") modalities, including mind-body medicine, that look for and deliver other solutions, often by taking a more "holistic" view of the problem itself. Not as a symptom that exists in a vacuum, but one that is part of an overall gestalt of the person's total physiological, psychological, spiritual and emotional health.
There's a form of acupuncture that professes to treat "body, mind and spirit." I once questioned a practitioner of this type about what percentage of ailments patients present with that she would ascribe to each. Interestingly, her response was that MOST patients' symptoms, well over 90%, according to their practice's teachings, were actually spiritual in nature. Hmmmn. Even if only 10% were, even if only 1% were, think how inadequate a purely pharmacological solution would be.
With something as complex as combat trauma, it's just another reminder -- this time from a superficially unrelated source -- to look beyond a single, too-simple, purely pharmaceutically-based solution, to something that captures the more complex, multifactorial experience of being human.
