Full disclosure, I’ve been on the inside with Big Pharma, lived with them for many years, found that experience both helpful to my practice and exceedingly educational. Their training proved beneficial to many medical folk throughout the land, as those dinner and lunch meetings cleared considerable street confusion about stimulant meds.
The pharma bashing we so often hear in psych/ADHD treatment offices arises from several different sources of misinformation
From The Past – The Relevance of Transference: The residua of the influence of psychoanalysis as the treatment modality for mind states. Freud’s intelligent understanding of the relevance of transference leaves some of the most careful coaches and therapists mixed up about passivity vs activity during the hour – activity – meds – could “mess up the transference and impede interpretation of the unconscious .” In psychoanalysis meds have been verboten for years, and recent, hesitant loosening of those uncompromising rules is regretfully slow. The transference phenomenon in the therapeutic hour, from my years of practicing psychoanalysis, seems quite indestructible, and expresses it’s presence quite impervious to therapist activity. From my own vantage point: transference can only be corrupted by overindulgent, repetitive direct advice ["do it my way"] – seen way too often in my second opinions following other “classical” psychoanalytic misadventures. The admonition in psychoanalysis and predominantly psychodynamic therapy: remain active in your own care, don’t become passive with meds = “Take care of yourself.”
From The New Attention To Addictions – Stimulants and the Addiction Process. As a psych certified [in past for 10 yrs] in Addiction Medicine, treating substance abuse for more than 22 years, I can report with great certainty that addiction-folk [professionals and those in recovery] still harbor considerable disdain for any med intervention process – again demonstrating a belief system resistant to change, and tediously slow to consider contemporary biologic neurophysiology in concert with the process of mind. Stimulants do more harm if they are not administered properly – an absolutely pervasive problem – as capricious practice is the unwritten standard of care in ADHD. Far too many write for ADHD meds who have no clue about how they work or what to expect. This “Recovery Disbelief” system appears to result from some of the mistakes, and partially from the resistance to “other care [passive]” to “self care [active].” Again, take care of yourself, no “pill magic.”
From the Psych Speakers for Pharma – Pharma Misrepresentation: Physician/psychiatrist speakers for pharma, seeking more speaking gigs [from more than 15 years of direct observation], have blown that important method of teaching by misrepresenting the science in categorical positive ways, without addressing relevant cautionary materials. Too many mixed speaking gratuities with the mission as “sales gigs” with real medical education. This unhappy circumstance arises from two distinct sources: 1. The pharma company sales team making decisions based upon consultant/academic insights that completely fail to review important literature – e.g. drug/drug interactions. 2. Physicians basing clinical judgements on appearances, the DSM-4r , not on brain function assessments or neurophysiologic inquiries. These misadventures occur following the process of simply not thinking about thinking. Metacognition , as a process of self-and-other observation is now out, but will soon be in. New does change thinking. The regrettable problem encouraged by some speakers: advocacy for “pill magic,” – by default against “pill science.” Their imprecision: “The pill will do it.” The public reaction = the current Big Pharma controversy.
From Uninformed Public Opinion – The New Biology Seems Unreal: Casual armchair psychodynamic interpretations, based upon populist psychiatric rim-shots [read "gossip"] – now appears too often as the agreed standard of most public insight. Even the well read love to talk about relationships and recognize that biology occurs beyond their scope of understanding . This vagary of information encourages additional energy for pervasive biologic denial. “What you don’t know can’t hurt you – and don’t tell me I have a biologic problem.” Further, public opinion exists in a corruption of all three of the first challenges, – as the public is well aware that 1. transference offers some help as a tool, 2. addictions are possible with stimulants and imprecise care, and 3. some speakers have indeed encouraged the imprecise use of stimulant meds. “Don’t trust the medical profession unless it’s life or death.”
My take on these four perspectives: The denial, the belief, the hope that Simple Solutions may apply to biologically Complex Problems is more culturally based than the result of Big Pharma. Big Pharma provides remarkably predictable solutions if we simply take predictable imprecision out of the medical equation. All of these observations arise from limited, uniformed perspectives – grasping only a piece of the big picture for ADHD recovery.
In this Thanksgiving dialogue with Madelyn Griffith-Haynie, MCC, SCAC author of the blog ADD And So Much More I hit some of the high spots regarding my take on why Big Pharma has taken so much heat in ADHD land. See this quick review from my experience, stumping on the national pharma circuit:
Full disclosure, I’ve been on the inside with Big Pharma, lived with them for many years, found that experience both helpful to my practice and exceedingly educational. Their training proved beneficial to many medical folk throughout the land, as those dinner and lunch meetings cleared considerable street confusion about stimulant meds.
The pharma bashing we so often hear in psych/ADHD treatment offices arises from several different sources of misinformation
My take on these four perspectives: The denial, the belief, the hope that Simple Solutions may apply to biologically Complex Problems is more culturally based than the result of Big Pharma. Big Pharma provides remarkably predictable solutions if we simply take predictable imprecision out of the medical equation. All of these observations arise from limited, uniformed perspectives – grasping only a piece of the big picture for ADHD recovery.
Use The CorePsych Perspective
Our ADHD Medication perspective at CorePsych: Take care of yourself, advocate for yourself medically, use medications in the context of the best information, find a medical practitioner who thinks like Russell Barkley PhD … who understands metacognition – thinking about thinking . This new complexity of the mind does require a coalescence of thinking – consilience as reviewed by E.O. Wilson in Consilience: The Unity of Knowledge .
PS: – And do tune in tonight, Nov 27, to the Coffee Klatch as these weighty ADHD medication and assessment matters translate into specific medical care for Special Needs Children .
Thanks again, talk soon,
cp
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