Posted by The plumber on August 13, 1998, at 5:32:17
In reply to Re: ambien, posted by Toby on August 12, 1998, at 12:02:03
Toby, your response regarding addictive substances clearly reveals your misunderstanding of NBD. You are obviously a CNP - a chronically normal person. CNP's, MD, PHD, - whomever - unless you have had severe NBD, you are in great lack of understanding. I apologize to the more "realistic" people, Md's PHDs, if they are able to understand- for many, many psychiatrists can get a "taste" of their patients inner being, especially after twenty-some yrs. of practice and research.
I will reveal your ignorance in a step-by step fashion: First, let me say that it seems as though you don't even understand the goal of psychopharmacolgy that is applicable. I had panic attacks, and I finally lowered my pride and made an appointment with Dr G. and I was immediatelly prescribed xanax. Let me tell you the story from the inside....
Yoga, meditations, breathing excersizes are fine for what Torrey terms WWW The walking worried well-people walk around smiling at themselves all day -"achieved" tranquility, inner peace. But what does this imply? (1) These people do not have serious clinical panic disorder. What if I told you to take medication A and told you that it won't work if you think about , say, a monkey. You will spend all day thinking of a monkey! The relation? It is a disorder in itself that people spend their lives using a "mental" "control" to alleviate a function of the brain. When you try to control something, so that it goes away, you necesarilly spend your days in some or another "method" and because you have it in mind to forget or alleviate the problem as such, the problem is constantly on the person's mind. Today I'll try Dr.premed's breathing excersises and then tonight I'll see if yoga can get me to sleep. If yoga doesn't work, then I'll take a hot shower and relax. Still uncomfortable, I'll stick with Psychology Today's program of "getting on with life" And, before I go to bed I'll read Bootsie's article that I heard has 5 simple steps that get rid of worrying.
Now I'm ready for bed...an hour, two hours...I end up with three hours of sleep a night. Take a look at this example and figure it out. This person is wasting their days, their very own life stuck up in all this 'methodology".
When I get up I'll keep thinking of my 12 step list which Bertha says is good. I'll concentrate on these till about noon, until, at the office Mr. Executive comes in to talk. I feel nervous because he is my primary boss. I get uncomfortable so I try the breathing excersizes and then abrubtly I'm asked a question, so I cough to distract him while i think of step #3. But then I notice that the executive sees that I'm anxious. Then, BAMM I loose my breath, my pulse is felt in every corner of my body, my arms get numb, my chest won't :move" and I have to quickly grab a tissue and pretend my nose is bleeding so that I can run to the bathroom and try to end the attack. I come out 10 minutes later, apologize, and continue talking while thinking of Yoga tonight, and following thursday's poetry line for the day - then the discussion is over and I can't beleive that this happenned. So I opt for step 6 of Breathings by Billy, and that requires me to take my shoes off and think of an ocean, or a bird. Meanwhile, I'm drenched from the panic attack, and worn out, but I must remember step 9 that says tomorrows another day.Now it's the next day, and the same basic routine. I'm either dwelling on the possibility of panicing, or I'm having a panic attack. And the next day....I get fed up so I go to a psychoanalyst who I see 4 times a week. We talk about my childhood fears, and I leave feeling more relaxed. But I have to go to the market - I go and BOOM another one. It doesn't let up. I finally come to the conclusion that I need to be medicated.
I go to Dr. Z and he prescibes an ssri for the panic. Or an other sedating med. It works to the extant that I only have two or three panic attacks a week, week after week.up to 12 when I think the med is working. Then, the next week, the nubness, lack of breath, it all comes back.Does this sound absurd to you? Imagine living it!~ And, if you think that a case as such does not ruin the lives of countless numbers of good people you are entirely mistaken - all of your patients lie to you! Now, lets describe the humane approach. This will be Dr.G Dr.G is compassionate. He does not go by rule A that says never give this or that med because they will become addicted. He is also not a sponser of rule B which says that psychiatrists should not "give out drugs". Now what is the difference? He (Dr.G) is not stubborn on some principle that the DSM makes. He is not insistent that Yoga, or, the worst, Mr. Hubbard might help. His thinking is not geared towards his own moral and ethical judgements. These are secondary. If I am predudice againast anybody who comes from Mississippi, that is my ethics - my learned morals and steryotyping and classifications. But its secondary. I know there is three people from Mississippi across the street. As I walk out to get in the car, I notice there is a fire. I now put what's right, what's wrong, what's addictive, what's "not?" addictive, what my morals dictate, my notions concerning ethnicity and education - all this is put on the backburner. Why, because my PRIMARY objective overides and surpasses all other principles - I run into the building, and save the three people from Mississippi. Why? Because i didn't stand on principle. I acted out of true duty that I owe to another human being. It's like driving in a car...Everone is in a rush and hates evryone when they are driving. This guy's a shmuck for getting in the left lane, this other guy is a shlemeil - going under the speed limit! Then, WHOOPS! I crash into shmuck #1. We are both o.k. We get out of the car and we are both in a shock state and the first question comes out from both people at the same time - "are you o.k.? That's the concern. Anger may come later, but that does not negate the fact that the shmuck with the grin on his face is as fragile and kind as you are!
Now you don't think this applies to a swift prescription of a benzodiazepine. My Dr.G prescribed it the first day. I'm sure he knew that I wasted alot of time, somewhat similar to the case above, and he also new that I needed immediate relief. He acted out not by principle, not by DSM but what he empathized in me. He put evrything on the backburner for a little; he went with his professional stature, and saw me as a human being who needed relief, who needed this to stop. It was my Dr. that prevented me from wasting more time trying to sqare the circle. Your argument is based on what-if circumastances. These are governed by hollow words. The instict to provide relief is based on true feeling and care, in a professional way, for a person that needed it.I'm sorry to tell you, but trazadone, one of your "miraculous" meds could cause sleepiness and Mrs. Penelope may veer off the road because of drowsiness. Cough syrup, that can cause an accident. Listen, if you can't be a mentch, if you don't have the guts to be a good psychopharmocologist/psychiatrist/whatever - get out! I sometimes wonder how many people walk around feeling like their lives are falling apart because their Doctors' are inadequate - they are afraid of "overprescribing" and "what -ifs?" And so the crises gets bigger. It's principle - not reality. I'm Mr. Lipshitz and I take 10mg of prozac a day. My Doctor is afraid to go higher. I go up to twenty. Then I see him rarely and I'm miserable, everyone tells me i'm mean and depressed, i sleep all day - why? Doctor prissy was scared. I won't mentioned the lost lives, the true non-survivors who fell into such circumstances. Read over your letter again, three times...and you will see that you are entirelly mistaken, or that you were in a mood and was playing devil's advocate.
Ahh.. you say - I'm not talking about prozac, I'm reffering to "unnecesary addictive controlled substances" - Any good clinician knows when it is appropriate to prescribe any med. If not, he is not working at full capacity. Yes, an SSRI followed - took about 6 months! My case happened to be quite more complex, I take "addictive" substances" that my Dr. prescribes. If he were to stand in your shoes, I would probrably be staring at the wall, or ranting and going off on tangents. I would have flat affect, etc. But now, I look good! Nobody would ever guess! Why? Because my Dr. and I worked as a team to try to improve the situation. He listned, and I respected. When I tell people they can't believe it. Why? One med that can easily cease to wake you up in the middle of a midnight fire. This is like water, something I need. I also take a II controlled substance - more than you think! Without this, I won't evn go into describing what its like to have no emotion. So, my Doctor prescribes this, very, very, constrained and supervised -= but he knows that it'slike water. He could say no and I would be very different and my struggles and obstacles would be multiplied beyond function. And the goodness in the situation is that, very tightly and restrictively, I am able to take a large dosage of II. I could get a roomful of people that know me and will all wave flags that say "He needs this medication!' I need others too, and i am not mocking anything that you prescibed in your letter (like trazadone). I'm merely getting the point out to whomever reads this message that the person facing the Dr. is a world in itself. And a good psychiatrist doesn't over-generalize. He treats each case as a distinct and unique person in all respects.
I conclude by saying that your "opening" line was indicative of an illness on your part. It was sick. Also, my above examples are VERY TYPICAL and if you don't know this then you really don't understand your own practice. Some patients can just do yoga. Some can go fishing. some need an immediate "addictive" substance. One end note: Haldol is heavy - Perphenazine - that wouldn't cause drowsiness! But xanax - or ambien - these will totally knock you out. Tolerance? Just like anything else - count the advantages and disadvantages. Don't think that people who only have a sleep/tired problem or someone with panic attacks is necessarilly an "option" for going light on the case - im most cases this person's life governed by unwanted whatever - and a psychiatrist doesn't see patients. Rather, a person seeks out a psychiatrist.
poster:The plumber
thread:93
URL: http://www.dr-bob.org/babble/19990501/msgs/290.html