Medication can help bipolars

Please don’t misunderstand me. This is not a paeon of praise for medication. However, Rappler’s recent article, “There’s hope for the bipolar worker,” was so down on psychotropic medications that I have to speak up.

Granted: Dr Ketter is not only Professor of Psychiatry and Behavioral Sciences but also the chief of the Bipolar Disorder Clinic at the Stanford School of Medicine. Still, that doesn’t excuse him from having downplayed that medication can help many bipolars.

I imagine that “What? Where? When? (Did he actually do that?)” are questions now running through people’s minds, perhaps especially the members of the People Management Association of the Philippines (PMAP) and Natasha Goulbourn Foundation (NGF) who organized his talk.

They may even actually quote Dr Ketter who, in the course of his talk, said, “A lot of individuals are able to find non-intrusive treatments like psychotherapy — with no side-effects — and which allow them to function normally and have a full life.” Ketter added that “non-pharmaceuticals (alternative treatments) may also get the job done with fewer or no side-effects. Psychotherapy, for instance, works well for adolescent depression. Anti-depressants are not recommended for people below 25 years old.”

They may even accuse me of witch-hunting, saying, “Dr Ketter never actually said outright medication was bad.”

To which I answer: “Ahhh, but there’s saying and there’s saying. There is also the meta-message.”

Meta-message

A meta-message is a message about the message. Alas, the best definitions for meta-messages, a concept vital when dealing with families, adolescents and individuals in trouble are not from psychologists and psychiatrists but from advertising executives like Andrew Goodman and Kevin Donlin.

The former writes: “The meta-message isn’t always literally what your ad says, but what elements of it – including format, positioning, and higher-order “slotting” in the user’s mind — convey.”

The latter says it is “the overall impression you give when communicating with others. It’s the “vibe” that extends beyond (meta) what you say (your message).”

Example, when the RH bill was passed, the meta message was that the Church is no longer as powerful as it once was. I feel that is the reason certain bishops and priests are trying so hard for “Team Buhay” to win. Because if they do, the meta-message will be that there actually is still a “Catholic vote.”

Psychotherapy has no side effects?

So back to Dr Ketter and my feeling that he was not even-handed when discussing treatments for bipolar disorder.

I interviewed Ime Morales, the author of the article. She is aware of the comments after her article and says, however, that the event was for HR practitioners,  and not one focused on treatment options. However, Ms Morales added that medication, along with psychotherapy and alternative therapy, were mentioned.

I followed up: “But Ime, you are an accurate reporter, not to mention a damn good writer, so if you wrote, however briefly, merely of psycho and alternative therapies, there must’ve been a reason.  I bet he either mentioned these 2 more or was slightly disparaging of medication — if only by being positive about the other two and silent about medication. Some call this damning with faint praise.”

Ime said, having listened once more to her tapes of the talk, that she agreed with me. 

Ime also emailed me the said tapes. In truth, however, Dr Ketter’s statements say it all. He underscores psychotherapy having no, and alternative therapies with fewer, or also no, side effects.

What Dr Ketter said about psychotherapy having “no side effects” is not true, and I would think someone in his position would be up on the current literature. Dr Louis Cozolino, author of The Neuroscience of Psychotherapy: Building and Rebuilding the Human Brain (2002, 2010), argues that all forms of psychotherapy are successful to the extent to which they enhance change in relevant neural circuits. 

There have been many books written since then which further show, perhaps in even more dramatic ways, how all forms of psychotherapy change our brain structures. I can cite their bibliographic details should anyone request them in the comment section.

Disdain for medication

My husband, who claims he is more realistic (read: cynical) than I, has added another example where a meta-message might have occurred.

NGF was one of two sponsors of Dr Ketter’s talk. This same article states: “Designer Jean Goulbourn, founder of the Natasha Goulbourn Foundation, lost her daughter Natasha to a lethal cocktail of anti-depressants.”

To say Ms Goldbourn died because of a lethal cocktail of antidepressants could be construed as suggesting that Ms Gouldbourn’s psychiatrist was responsible for her death. 

Even if I believed Ms Goldbourn died because of the medication she took (which I don’t necessarily) I feel using the word cocktail , instead of say combination, of antidepressants implies greater culpability, a cocktail bringing visions of frivolity and fun. 

Jeremy’s hypothesis is that Dr Ketter picked up on Jeanne Goldbourn’s disdain for medication and belief in wellness centers (meta-message) and probably thought no harm was done by downplaying any role for pharmaceuticals and, thus, not offending his sponsors. He may have even done it unconsciously.

And I don’t really blame him if that were the reason; many would’ve done the same.

Not excluding other therapies

I hope I do not come across as pro-medication to the exclusion of anything else. I hope I do not even come across as insisting, or even merely suggesting, all bipolars take medication.

I know psychotherapy works (hopefully, especially when I am the therapist). I feel some alternative therapies might, but so far, research has not proven consistently, convincingly and unequivocally that they do.

It’s just that psychotropic medication has been given such a bad rap that anything that fails to show its pros and cons more accurately should be questioned. – Rappler.com