Often, but by no means always, clients who come to see me are on medication (prescribed or otherwise) to alleviate the symptoms of psychological difficulties. It is important for a counsellor to know if clients are on medication because this can affect the process of therapy.
Many clients will want to come off this medication as soon as they feel confident enough to do so. Some will try to do this prematurely or without doing it gradually. Others will see their medication as a lifeline that they cannot envisage ever letting go of. If I am asked for my advice it is invariably the same – be guided initially by your own sense of readiness but don’t make any changes without the agreement, or at least knowledge, of your GP. But what is the basis on which such medication is prescribed in the first place?
A few weeks ago I attended a presentation by Dr James Davies, a psychotherapist and co-founder of the Council for Evidence-based Psychiatry and a senior lecturer in social anthropology and psychiatry at Roehampton University.
Dr Davies is the author of a number of publications that have raised serious questions about the practice of psychiatry and in particular the prescribing of medications intended to address psychological difficulties.
His presentation was about the ‘DSM’, or to give it its full title, the Diagnostic and Statistical Manual of Mental Disorders. This is the authoritative publication on what symptoms constitute the various forms of mental disorder; it is the psychiatrist’s key diagnostic tool.
The manual has been revised a number of times. Its third incarnation in 1980 brought greater uniformity and consistency to its classifications. The initial print run was massively underestimated and it sold out almost immediately.
But Dr Davies’ careful examination of the factors that were considered in producing the DSM does raise doubts about the basis on which many tranquillisers and antidepressants (collectively known as ‘psychotropic’ medication) are prescribed today. The Bristol and District Tranquilliser Project, which hosted his presentation, was set up thirty years ago to help people who are having problems with these drugs withdraw from them and to ‘lead normal lives after withdrawal, without recourse to any psychotropic medication’.
BDTP points out that prescriptions for antidepressants have quadrupled in the last twenty years and that the current four million people in England currently taking such medication is increasing by 10% a year.
It has almost become a cliché to say that doctors prescribe tranquillisers and antidepressants because they simply don’t have enough time to spend with patients, or because the NHS just doesn’t have the resources to offer anything more than short term counselling as an alternative to psychotropic medication. And of course it’s easy to generalise.
But there was a reason why DSM-III sold out as quickly as it did (we’re now on version DSM-V by the way). The DSM filled a void in the provision of properly targeted talking therapies, a void that still exists today.