Day 18.01 needed:

Day 18.01 needed: (Photo credit: Frerieke)

For mental health consumers and their psychiatrists, medication compliance is a big issue. We often do not want to take a medication which we feel is not helping or that has undesirable side effects. Many doctors react to this by treating us like idiots when we are actually talking about legitimate concerns, at least most of the time.  This creates a polarization on both sides, which unfortunately may actually cause the client to be less compliant or even drop the treatment altogether.

Doctors tend to use the word non-compliance as an epithet and an insult. Once I was in the hospital for a serious infection. I heard a doctor nearby talking on his cell phone. He practically spit the words out, “She’s an idiot, she is non-compliant.” Now I cannot judge whether she was or was not an idiot, but what I can say is that it is likely that she had a legitimate concern about the treatment and just wanted the doctor to work with her on that.

The word non-compliance has no negative meaning whatsoever. It means simply this:

noncompliance n. Failure or refusal to comply.

Here, for contrast, is the definition of compliance:

com·pli·ance

1. the act of conforming, acquiescing, or yielding.

2. a tendency to yield readily to others, especially in a weak and subservient way.

3. conformity; accordance: in compliance with orders.

4. cooperation or obedience: Compliance with the law is expected of all.

Here is how doctors usually define it:

In medicine, compliance (also adherence or concordance) describes the degree to which a patient correctly follows medical advice.

Neither of these terms have a completely negative or a completely positive definition. They are statements of fact, not value judgments.

Although general conformity can be a good thing on the job, with a doctor and in society in general, we also should consider the number two definition from above:

a tendency to yield readily to others, especially in a weak and subservient way.

For most of us mental health consumers, the best way we can get well and stay well is to take charge of our recovery instead of expecting others to fix everything. To treat doctors as gods does nothing to achieve that goal.

There may of course be those who are out of touch with reality to the point that they are incapable of making rational decisions, but that is a separate issue altogether and I am not addressing that in this article.

Returning to the medical definition of compliance there is a word here that a lot of doctors would rather not acknowledge:

In medicine, compliance (also adherence or concordance) describes the degree to which a patient correctly follows medical advice.

Yeah, that’s right, advice. Not orders.

Most people consider that medicine is a totally hard science. It isn’t simply because we are still learning how the body works. Not only that, but because we are not biochemically identical no doctor can predict what effects a particular medication will have on us, whether it be good or bad. Finally with many medications (not just psychiatric) they don’t even know exactly how a medication works. The fact that they don’t know does not usually affect the efficacy of the medication, but it does mean that it is not fully understood and therefore I do not consider the practice of medicine to be wholly sacrosanct. For instance, there are still disagreements as to how antidepressants help depression.

After saying all that, I think that it is a bad idea to chuck medications down the toilet. I have witnessed the damages that happen when people do that. I have not only experienced it myself, but also fairly recently with a friend who decided to go off his meds and had a serious schizophrenic relapse.

My solution is to educate myself and look at the pros and cons of taking a particular medication. After all, even something as innocuous as aspirin can kill you. It can cause bleeding ulcers or aggravate bleeding disorders. One man’s medicine can be another’s poison, which is why it is important to talk with your doctor.

Which brings me back to my original point. Doctors of any specialty need to treat their clients with dignity and respect, and address their concerns about their treatment fairly and without condemnation. The doctor is performing a service for us, not the other way around.

In my next post I will get into my personal experiences with some doctors and what I believe are unproductive attitudes on their part.

* I use the term “musical medications” comparing them to the child’s game of musical chairs. The random process of trying one drug after another and waiting for them to work is a hard one to deal with. So don’t worry, I am not “crazy” LOL  😉

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