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Dr. Ronald Ricker and Dr. Venus Nicolino Headshot

The Patient Is a Person

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With all the headlines being made by Health Care Reform and the subsequent controversies surrounding it, many of the weak points of American Health Care have been exposed. One issue that has received little, if any, scrutiny is the sadly anemic condition of not just the treatment itself, but the philosophy of mental health treatment in America. To us there seems to be a true loss of awareness: The awareness that those seeking treatment for mental disorders or illness are human beings in need of empathetic and therapeutic care, not just mouths in which to stuff psychoactive drugs.

By way of example, Dr. Ricker was recently visited by a 24 year old young man who had just spent two weeks as a psychiatric inpatient in a very well known University Teaching Hospital in Los Angeles. He had been discharged the previous day.

Upon entering the office, the patient was stiff, clumsy, and absent of any apparent emotion or other emotive affect. His speech was flat and monotone. There were the usual greetings.

Then, immediately, the patient began reciting a pharmaceutical laundry list of the medications he'd been given at the Hospital, including very large amounts of two major anti-psychotic drugs, an unnamed anti-depressant and a very large amount of a drug called Neurontin.

"Have you been taking these long?"

"Two days", he said. Considering the mammoth dosages of drugs coursing through his veins, he was lucky to be walking or even speaking at all (Did he drive to this appointment all jacked up on pills?)

"You had a Doctor at the Hospital?"

"Yeah", he said.

"Did you two spend time together, trying to understand what needed to be set right inside you?"

"I never met him", was the response.

"Did you have a therapist?"

"Yeah, I did."

"Did you two spend time together, trying to understand what needed to be set right inside you?"

"I met her once. She was nice."

"How did you get these medicines?"

"I went to a conference," he said.

"They decided there?"

"I don't know."

"Did anyone talk to you about these medications? What they do, possible problems, side effects, stuff like that?"

"No. A nurse just brought them to me and asked me to take them. I slept for a whole day."

After only a few minutes into the scheduled hour-long session, he wanted to leave. Another appointment was made for a few days later. He left and never returned.

Another Doctor found to be working with the same patient was contacted, and asked if something had bothered the patient during his visit with Dr. Ricker. "Yeah, he could tell you wanted to talk. He only wanted someone to give him his pills."

Another case of a Doctor mistaken for a drug dealer. So it goes. Dr. Ricker pressed his colleague. "What's with the 5000 mg. of Neurontin?"

He answered with the tone of one explaining why the sky is blue to a toddler. "Don't you know? The drug of choice for anxiety disorders is Neurontin."

Actually, that's an off label use that's very likely ineffective and dangerous. But hey, what's a few dead folks here and there when there's cash coming in? Have a steak on Pfizer.

The Resident in charge of the ward where the patient had been knew nothing about this man's life, family or any other aspect of his personal history. He added, that a drug regimen like that was "Standard for cases like him."

In other words, it's standard procedure to pill-stuff a patient like a foie gras goose, often without knowing anything about the patient and the patient knowing nothing about the drugs. The only way Hippocrates could smile on this would be would be if he were blindly intoxicated.

Is this what the science and art of psychotherapy and psychiatry has been reduced to? Don't talk, don't question, don't get to know the patient. The Doctor's role is to be the last part of the conveyor belt leading from the pharmaceutical plant to the patient's mouth. Any kinks in the line will result in the worst-case scenario for all involved: Loss of Profit.