“Standard of care” is one of those terms that people in the medical profession throw around the way models toss their hair back when they swivel around on the runway. It’s the standard and if you’re not giving the standard you’re just no kind of doctor at all. And for a patient to refuse it…well, that’s when the trouble starts.

For as along as I’ve been alive and especially when I was younger, it was an accepted standard in American life that we could choose our treatments. We could take a toot of that elixir or not. We could wash our hands before we ate or not. We could choose our doctors and get second, third or fourth opinions without facing a tribunal of bureaucrats telling us to “open wide or else.” We did not have to submit to endless procedures, useless and expensive tests, “medicines” that caused more damage than the diseases they were supposed to be treating, or doctors we not only didn’t like, but didn’t respect.

Karen (names changed), and her mother, Lois, live in a fairly busy suburban area in the northeast. Recently both were unfortunately placed in this position. It is a disturbing but familiar story.

Karen, who is still an adolescent, was misdiagnosed with “standard” depression because she was anxious and had expressed a profound weariness with life. The anxiety had truly depleted her vitality. She felt she could not defend herself against it. Although she made it clear that she had no plan to kill herself, as soon as she’d confided her feelings the authorities took over. “She was in danger,” the therapist determined and convinced the mother that she HAD to take her to a psychiatrist who would put her on anti-depressants.

They did. That was mistake number one. Because Karen was not depressed. She was either borderline or a prodromal psychotic. Mostly her anxiety and the resulting OCD behaviors were a function of her delusion that people disliked her, were watching her, and laughing at her. She was agitated.

In allopathic medicine, SSRI’s (typical and atypical anti-depressants) are highly contraindicated in people with psychotic features. Especially in young women.

But they scared Lois enough that she gave the okay. The truth was that even if she had said no, someone would have eventually called CPS (Child Protective Services) and forced the situation as an issue of child neglect.

With the SSRI in her system, it only took two weeks for Karen to deteriorate beyond recognition. She went from anxious and weary to overtly suicidal, self-destructive and self-mutilating. If she couldn’t cut herself with a knife, she used her nails and her teeth. She was losing her mind.

According to the standard of care, she was hospitalized.

And in the hospital, what did they do? They doubled her dose of SSRI’s. They also added sedatives so she’d stop crying for her mother and the therapist who wouldn’t visit her while she was in-hospital (so she would “bond” with the management and therapists there).

The outcome: She was sedated and grossly disorganized. The delusions got worse. The anxiety got worse. The self-loathing got worse.

The decision: Up the meds! Up the meds!

So they upped the meds. And she got worse.

All the while, the doctors wrung their hands and clucked about how Lois needed more patience. Sometimes, according to pharmaceutical protocols, the levels have to get very high before they start to work. "You wouldn't want to take any unncessary risks, would you?"  And then the inevitable, "We really think you need to go home and let us handle this." Not to mention the whip of viral fear, "If you can't stop being obstructive we will have to call CPS."

Meanwhile, Lois was terrified that if she made too much of a stink they’d call CPS and take her daughter away from her. She knew the meds were making it worse from the very beginning. She knew the research. She also knew that SSRI’s are highly contraindicated in young women, particularly when there are psychotic or borderline symptoms.

I’ve known Lois for nearly 30 years. She is not easily terrified by anything. She is bright, persistent, and capable in a dozen different areas. And she’s a fighter. For the first time, she was terrified. They had her by the short hairs. They had her daughter in lock up. And they wouldn’t release her. And they kept feeding her medication that was making it worse.

What do we do with this? Do we accept this as a standard of care?

Is there any care whatsoever in that standard?

Here’s how it resolved: The insurance ran out.

As soon as the money was gone Karen was released. She and Lois agree that she will continue with a counselor in private practice who specializes in the treatment of borderline kids. She will also seek her alternative medical support from a capable, classical homeopath. They’re done being afraid.

But how many others are stuck in the vise grip of that sort of treatment? How many others know to even ask about the research on SSRI’s with borderline youngsters?

]]> http://viralfear.com/2009/09/05/standard-of-care/feed/ 2