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Imagine if you suffered from anxiety disorder with symptoms like panic attacks, hypervigilance, palpitations, sense of doom, excessive worrying to name just a few. Imagine that you had especially severe form of such disorder and that one of the treatments that helped you was taking one of benzodiazepine medications such as lorazepam (Ativan) or clonazepam (Klonopin). These medications have been used for therapeutic use for many decades, and, when used properly can be extremely beneficial, according to leading experts in the field (e.g., Stahl, 2002).
Now imagine, that after years of successful management on such medication, your doctor hands you a form in which she/he ask you to initial and sign that you understand that they may randomly urine or blood drug test you—the implication being that if you’re taking medication for anxiety, somehow you’re likely to be taking other unauthorized medication or illicit drugs.
Really? If you’re taking medication for diabetes, do you also have to sign a form that you’ll allow to be blood tested to see if you’ve had that extra donut you were not supposed to have? What about one drug that accounts for most deaths—alcohol? Some people abuse it, but should that mean that everyone who buys alcohol should sign similar type of waiver forms? No, of course not, but only because in the latter case there is no liability to anyone.
It's difficult to understand why healthcare providers thought it would be therapeutic to ask someone with anxiety disorder to sign a form filled with pseudo-legal and troubling jargon (and, yes, ANXIETY–inducing jargon) such as “If legal authorities have questions regarding your treatment… you are waving confidentiality” or favorite buzzword on the form which is “the Sheriff’s Department.” Ah, what a wonderful therapeutic environment doctor’s office has become.
There are also statements on the form which are not entirely accurate. For example, one statement reads that “benzodiazepine medications will unlikely provide complete relief.” This statement is coming from doctors trained in Family Medicine, with limited knowledge and understanding of mental health or its treatment. Also, this statement is more of an opinion, and certainly not in complete agreement with opinion of psychiatry specialists (e.g., Stahl, 2002) who concludes one of his article with:
“So, go ahead and feel less guilty about combining GABAergic and serotonergic treatments for anxiety. You have lots of company and a scientific rational for this practice.”
Whereas in many countries in the world general practitioners are not even able to prescribe psychotropic medication—as that is considered outside the scope of their practice—they seem to do a lot of psychotropic prescribing in the United States. In fact, primary care physicians prescribe some 80% of all psychotropic medication in the United States. So, those physicians who have least amount of training in diagnosing and treating psychiatric disorders prescribe the most psychotropic medications, and now are beginning to codify language that puts them in even greater position of power while further demeaning (e.g., urine testing) patients who are already, by their nature of being a patient in general and being mental health patient in particular, in a very vulnerable position.
Medicine has never been entirely on patients’ side. Think of its silent establishment during ultra inhumane “pre-existing condition” era that left many patients dead. Of course, I assume that most doctors mean well, but they are part of the system and it is understandable that they conform to systemic pressures and at times want to protect their licenses and against liabilities. However, there is a productive, humane and effective way of doing such things without demeaning and pseudo-criminalizing those who suffer. These patients are not in the position of power, and as such they maybe perceived as an easy target for intimidation, control and even criminalization. However, these patients also have advocates. Psychologists and other legal and medical scholars will sooner or later stand up to these types of subtle, and not so subtle, intimidation attempts.
Patients themselves will also speak up against such uneducated, ill informed, and ultimately dehumanizing and nontherapeutic form of communication.
References
Stahl, S. M. (2002). Don’t Ask Don’t Tell, but Benzodiazapines Are still the Leading treatment for Anxiety Disorder. Journal of Clinical Psychiatry, 63:9, 756-757.
