According to a piece I heard on NPR a couple days ago suicides are up in Greece. Is this because of reduced availability of psychiatric treatment or factors more directly related to the country's economic problems?
In psychiatry we have a tendency to associate suicide with mental illness. Since we believe we can treat mental illness we have promoted the myth that we can prevent suicide, but with unintended negative consequences. For example, wrongful death represents one of the top claims in psychiatric malpractice suits. Because of this, those of us in a position to do so shun risky patients, making it more difficult and costly for them to find care, and possibly increasing the risk they will kill themselves. If we get stuck with caring for a risky patient the focus shifts from optimizing treatment (assuming there really is an illness to treat) to desperate attempts to control the patient's behavior.
We should accept that suicide arises almost always out of free choice and focus our efforts on treating illness instead of pretending that we can control behavior. Even when patients who suffer from mental illness choose to end their lives the motivation may have little or nothing to do with the illness.
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Ugh. Just had an awful thought. Were the atypical antipsychotics such a hit with so many docs because, despite all the weird side effects (I'm looking at you, diabetes) which could be blamed on patient lifestyle choices, these drugs were somehow effective at preventing suicide (and thus a lawsuit prevention measure)?
ReplyDelete(Just wondering out loud. I don't actually know whether the AA's actually left one a live mess instead of a dead one...)
Good question anon. It may be that only lithium has any effect in preventing suicide, but it may be the perception that counts. So if docs believe a drug will prevent suicide, even if it makes you a zombie in the bargain, that's may be what they prescribe. Reminds me! I just looked up chlorpromazine (Thorazine) in wikipedia. In its early days they actually thought it would induce "artifical hibernation!"
ReplyDeleteI agree. Suicide is rarely the psychiatrist's fault, unless he failed to provide adequate care. One of my friends killed himself because his psychiatrist refused to treat him and his depression would not get better. But it was still his choice. I'm not a fan of suicide prevention efforts that aim for zero suicides. I want my choice to live or die. I just want to know there's help for me if I choose to live.
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