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by Carol Fisk Owais, M.D., and Wisam Owais, M.D.
When people come to Pine Rest for treatment, they are first evaluated
to determine the nature of their illness and the most helpful treatment
approach. Treatment often includes individual counseling, education, pastoral
counseling, family therapy, and group therapy. Another aspect of treatment
may be medication.
Whenever a psychiatrist recommends that medication be part of a treatment
program, patients and their families may have some ethical and spiritual
concerns. The treating physician should be sensitive to these concerns
and answer them openly before embarking on a course of treatment that
involves the use of medications.
The cause of much of the controversy surrounding this subject lies in
the tendency of some people to view illness as either a totally physical
or a totally emotional/spiritual phenomenon. This "either/or"
pattern results in two opposing sets of reasoning:
- All psychiatric illness results from emotional and spiritual causes.
Therefore any use of medication represents a crutch or "bandaid"
approach that undercuts the process of recovery involving emotional
and spiritual struggle.
- All psychiatric illness results from disturbances in brain chemistry
and can best be treated with chemical agents to restore normal functioning.
Emotional and spiritual factors have little relevance in this process.
However, neither of these views adequately describes the complexity of
human illness. There is growing evidence that emotional and spiritual
difficulties are associated with increased vulnerability to physical illness.
(e.g., There is a significant increase in the incidence of serious physical
illness during periods of mourning and grief.) Similarly, physical illness
and chemical disturbances in the brain often manifest in mental and emotional
symptoms. (e.g., Severe deficiencies of critical nutrients such as vitamin
B12 can cause mental depression or confusion.) Humans consist of an integrated
whole of body, mind, and soul--none of which can be viewed separately.
The greatest success in treatment is usually achieved when all aspects
of the person are addressed simultaneously.
Children and adolescents experience many of the same psychological problems
as adults. However, they are not "miniature adults." They often
act differently from adults when they are depressed, out of control, or
anxious. They are evaluated in the context of family and school. Their
treatment focuses on helping rebuild their relationship with their family
and restoring their ability to function in school and prepare for life.
If medications are needed in their treatment, they are prescribed with
the full understanding and consent of their parents and are carefully
monitored.
The severity of the illness often determines the choice of treatment.
For example, a mild case of diabetes can often be controlled by the proper
diet and weight control, while severe diabetes requires the use of insulin.
A mild depression can be helped with counseling, proper rest, diet, and
exercise. When a depression becomes so severe that it interferes with
a person's productivity, interpersonal relationships, spiritual life,
and daily activities, anti-depressant medication is necessary. This medication
corrects the abnormality of the neurotransmitters in the limbic system
of the brain.
Here's an example. Harold, a 50-year-old engineer, was functioning well
at work and at home. Then his wife noticed that he began to withdraw to
his room whenever he was at home. Next he stopped eating. He became restless--pacing
the floor. Harold cried easily and could not sleep. He stopped going to
work. He became obsessed with feelings of guilt, believing that his prayers
were pointless and his life had lost its meaning. Finally he went for
professional help. A psychiatrist prescribed an anti-depressant medication
for him, and Harold also became involved in individual psychotherapy.
Within a few weeks, his appetite returned and he became more relaxed and
hopeful.
Anti-depressants are not addictive or habit-forming. They do not change
a person's basic personality or produce an artificial "high."
Some anti-depressants are also useful in the treatment of anxiety and
panic attacks.
Another condition that responds successfully to medication is mania.
Sue often embarrassed her friends and relatives by her attitude and behavior.
Suddenly she'd have boundless energy, require no sleep, run up thousands
of dollars of credit card charges, talk of grand schemes to save the world,
and say whatever came to mind--including rude comments and profanity.
Trying to talk reason with Sue did not help. Medication did.
When Sue and other people suffer a manic episode, their entire body seems
"speeded up." A chemical change in their limbic system keeps
them in this abnormally accelerated state. They need a mood-stabilizing
medication to correct the condition.
Lithium is a salt that acts to stabilize mood, allowing both the body
and mind to return to their normal states. It also helps to prevent a
recurrence of mania or a switch into depression. Many people with manic-depressive
illness are able to return to their productive, creative, and fulfilling
lives after the proper dose of lithium is maintained in their system.
Several other medications also successfully stabilize mood.
Major tranquilizers (anti-psychotic medications) are another group of
medications. Psychiatrists use them in the treatment of mental illnesses
in which the person becomes out of touch with reality and may behave in
bizarre ways. People and objects often appear distorted. The person may
hear strange and frightening voices when alone.
An example is Judy. She had always been a diligent and good student.
A bit shy, she enjoyed reading and playing computer games for hours in
her room. Judy's parents were proud of her scholastic achievements. They
were glad she respected her teachers, meticulously cared for her appearance,
and enjoyed worshipping with them in church every week. After graduation,
she was accepted at a well-respected college. Her freshman year was difficult,
and her grades were much lower than she had expected. She didn't make
friends easily, and she became even more isolated and spent hours daydreaming.
When Judy returned for the beginning of her sophomore year, she told
her parents that several of the students and faculty were conspiring to
make her drop out of school. She believed they were controlling her thoughts
and sending messages to her through the college radio station announcer.
Judy's parents went to see her and found her room in shambles. They could
hardly believe she was wearing dirty clothes and had obviously not washed
her hair for days. Judy then told them she was hearing God and the devil
argue. She said she continuously heard voices screaming at her. Judy's
parents took her to the Student Counseling Center. A counselor recommended
psychiatric hospitalization. With supportive psychotherapy, antipsychotic
medication, and encouragement from her parents and church, Judy began
to improve.
Because many illnesses have disturbances of the physical, emotional,
and spiritual aspects of a person, these all need to be addressed. Some
people think psychiatrists prescribe medications to "dope someone
up." This is not an appropriate use of medication. Actually, medications
help stabilize the patients' brain chemistry so they can effectively deal
with their problems. When a person is on medication, his/her psychiatrist
carefully monitors the dosage, response, and the length of treatment.
As with any other medication, side effects can be an issue. Most are
mild. Common side effects include drowsiness, dry mouth, or increased
thirst. Since everyone's body chemistry is different, some people may
not have side effects while others are more troubled by them. If side
effects are more severe, they can usually be managed by changing the dose
of the medicine or the time of the day the patient takes the medication.
Fortunately, the science of psychopharmacology has advanced rapidly in
the past few years. Alternative medicines are available and can be used
if a person is sensitive to a particular one.
The appropriate use of medications has brought relief from suffering
to countless individuals. When medications are prescribed by a skilled,
caring psychiatrist, they can be life-saving and instrumental in restoring
spiritual, physical, and emotional well-being.
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TODAY: The Illness of Mental Illness
Dr. Carol Fisk Owais received her
medical education at the Loma Linda University School of Medicine. After
an internship at Harding Hospital, she joined the Department of Psychiatry
at Ohio State University where she completed her residency training in
psychiatry and was appointed Clinical Instructor. She was active in the
private practice of psychiatry and served on the psychiatry faculty at
both West Virginia University and East Tennessee State University. Dr.
Owais was a senior staff psychiatrist for Pine Rest's Partial Hospitalization
Program. Her special interests are in the areas of mood disorders, psychopharmacology,
and the interface of psychiatric and neurological disorders.
Dr. Wisam Owais pursued his medical
education at the Loma Linda University School of Medicine. He completed
his residency training in psychiatry at Ohio State University where he
was Chief Resident of Psychiatry and Child Psychiatry Fellow. He joined
the faculty of West Virginia University and later of East Tennessee State
University and was active in the private practice of psychiatry. When
he was a senior staff psychiatrist for Pine Rest, Owais supervises the
treatment team for the Short-Term Adolescent Unit. His areas of interest
include the integration of psychotherapy and pharmacotherapy and the interface
of religion and psychiatry.
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