Archive for December, 2008

A Psychiatrist speaks from good conscience…

Monday, December 8th, 2008

An article by psychiatrist Dr. David Kaiser in the Psychiatric Times gives us a glimpse of the chasm that continues to widen between biological psychiatry and more humanistic psychiatry. It’s one thing for those of us outside the profession of psychiatry and psychology to point our fingers and say “something’s wrong”, but it can not be said clearer than from inside the family. There is plenty to debate in this field of endeavor since it’s so subjective to the observer and to date medical science has not been able to find it’s holy grail of evidence that aberrative mental states or inappropriate emotional distress comes from a physical source exclusive to the brain. We, in nursing or any other health field, do not have to answer the question of “what’s it coming from” to chose a therapeutic intervention that doesn’t harm temporarily or permanently the sufferers while we look for a conclusive, acceptable and workable answer. Here is one of the many quotes I’d like to bring to nurses in the psychiatric field to think with while they treat their patients:

“I am constantly amazed by how many patients who come to see me believe or want to believe that their difficulties are biologic and can be relieved by a pill. This is despite the fact that modern psychiatry has yet to convincingly prove the genetic/biologic cause of any single mental illness. However, this does not stop psychiatry from making essentially unproven claims that depression, bipolar illness, anxiety disorders, alcoholism and a host of other disorders are in fact primarily biologic and probably genetic in origin, and that it is only a matter of time until all this is proven. This kind of faith in science and progress is staggering, not to mention naive and perhaps delusional. ”

This organization, Nurses for Human Rights, is dedicated to changing the idea that treatment of patients in mental health requires chemical restraints, electroshock, deprivation in institutions, forced drugging or forced shock treatments, etc. Let’s follow the motto of our predecessors of “First, Do No Harm”. We are ingenious enough to come up with a better solution, even if it means to abandon the current model. But we first have to break from the mental chains of a false doctrine, that mental illness is biological. It both leads to more calamity for nurses and their patients and denies the possibility that man has a spiritual nature, that the mind is more that a brain and nerve network, and that mankind is limited to only being the effect of chemical reactions and wholly at the mercy of the environment. I don’t agree with that viewpoint, and never will.

Antipsychotics: Restraints for the Elderly? Good question…

Friday, December 5th, 2008

The American Journal of Nursing printed a great article in their Viewpoint section from Marcia Lynn Weiser, RN, CLNC, soon to be MS at USF. She writes that “Nurses shouldn’t rely on these drugs for residents with dementia”. With black box warnings about early death and the multiple side effects of psychotropics, we have to re-think the care of the elderly and how we manage restless or agitated seniors with or without dementia diagnosis. She rightfully questions the ordering of antipsychotics as a means to manage these patients since it has been shown to be largely ineffective for dementia and are “associated with falls and fractures.” She correctly sites the nurse to patient ratios as a reason for the increase use of antipsychotics to “manage” the restless and agitated dementia patient. I see this as very true being that I know many nurses in the LTC arena who are constantly supporting this viewpoint. And who gets “written up” when a patient falls or hurts themselves?

There’s a later article in the AJN December 2008 “In the News” section where they offer good ideas to better help manage dementia patients that don’t require drugs. Really, the art of Nursing is just such in this over-medicated world. We can be more creative in our care than to drug people into submission. We are only cutting their lifespans and the quality of life. It is their Human Right to live without being enslaved by mind-altering, sensory depriving drugs. They have a right to life, to not be enslaved by chemical restraints. Nurses, let’s protect their Human Rights and question the use for our patients.