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by Ronald J. Diamond
W. W. Norton, 2011
Review by Roger Hunt on Jun 11th 2013

The Medication Question

The Medication Question examines important concerns facing patients diagnosed with a particular mental illness.  Unlike many texts addressing this issue, it remains neutral to the political and philosophical issues of pharmaceutical treatment, and instead explores it from a patient-centered approach.  Rather than ask questions like "Is medication an effective treatment for mental illness?" or "Should the government be funding research or paying closer attention to prescription criteria?", Dr. Diamond explores whether or not medication could be an effective treatment for particular patients and what kind of impact such interventions will have on his family, work, and social life.

Each chapter focuses on a different diagnosis, and covers everything from substance abuse to bi-polar disorder and schizophrenia.  They are broken down into clear sections designed to help the reader think through the particular condition, rather than understand it technically.  This approach is refreshing, and since it is written in very simply language, high school students and professionals from the mental health field alike will be able to understand and hopefully think about these conditions in a new way.     

The chapters have a very clear and helpful progression.  First, Dr. Diamond describes the diagnosis as it affects patients.  For instance, in the chapter on anxiety, he doesn't simply list the DSM criteria, but instead explores depression from the perspective of the patient, how it feels to have depression, and what it's like being treated for it.  This section is broken down into a series of questions such as "Does your anxiety make sense to you?"(p.19) and "What are you doing to take care of yourself?"(p.20)  Dr. Diamond uses easy to understand descriptions with plenty of simple case material which especially helps the reader who may not be suffering or doesn't know it yet. 

After introducing the experience of the condition, he explores nuances in diagnoses.  The section in anxiety explores stress, panic attacks, post-traumatic stress and phobias to name a few.  He then clearly outlines the varieties of treatments such as therapy and medication that psychiatrists will likely prescribe for patients.  Diamonds writing style and presentation walks the reader through the psychiatrist's thought process without relying on jargon.  One gets the sense that psychiatry is really more of an art than a science.  It seems that psychiatrists are rarely ever able to offer patients a "quick fix", but instead they are constantly evaluating and adjusting doses, medications, and recommendations for therapy.

Diamond's views on psychotherapy are also refreshing.  In our hyper-pharmaceutical age, many patients and even providers may get the sense that talking about issues in a therapeutic environment is passé.  However, Diamond is constantly urging patients not only to rely on medication, but rather use it to help them live happy and healthy lives.  He thinks of medication as a supplement to other forms of therapy including cognitive-behavioral therapy, psychotherapy, and even psychoanalysis or even simply working to be aware of your own state, exercising often, and eating right.  The medication is valuable because it increases the likelihood that patients will have more success in therapy and other interventions, not because it means you only have to see your shrink once a month for refills.

Building further on this theme, Diamond is particularly sensitive to how mental illness affects family, friends and work-life balance.  He constantly recommends that patient invite help from loved ones as he begins medication and therapy for mental illness.  Patients need to recognize that their conditions have a serious impact on their lives and the lives of those around them, just like having the flu or even cancer takes its toll on everyone involved, and that the love and support is critical to maintaining balance, and perhaps even recovery or cure.

The final chapters of the book explore mental illness more generally.  He explores what it means to understand one's own mental illness, the stages of finding the right medication and therapeutic intervention, and what it means to take responsibility for your own mental health.  He asks the reader to take stock of his current situation, consider how he will present his mental illness to a provider, and how he can self-monitor throughout treatment.

This text is a mix of self-help and a demystification of the DSM, the bible for mental health providers and insurance companies, and thus will be interesting to many readers including scholars looking for an easy reference guide on mental health, patients looking for self-understanding, therapists looking for a brief and clear exposition of pharmaceutical treatments, and psychiatrists who may treat diagnoses rather than patients.  However, I worry about the person who is not taking the necessary steps to control their mental illness.  Maybe this person routinely goes on and off medication, is in and out of therapy, or only addresses the issue when it becomes a serious problem.  While Diamond takes great care to be considerate and neutral, taken out of context these chapters could be understood as down-playing the seriousness of mental illness.  For example, if someone reads the chapter on depression, locates his particular diagnosis, say major depressive disorder which Diamond describes as, "a depression severe enough to significantly interfere with the person's ability to function" on page 65, then turns to page 72 to find that exercise can be an effective treatment, I imagine it is possible that this person will simply start exercising a lot, rather than making regular appointments with a therapist and psychiatrist.  In this case, a text meant to be a clear, accessible, and honest exploration of mental illness could become a serious road block to someone's recovery.  As such, I am happy to recommend this book to anyone interested in mental illness, but would be wary of giving it to someone as a way covertly suggesting they should start treatment.  When seeking treatment for oneself or others it is crucial to follow Diamond's suggestions in the latter half of the book: develop a list of priorities; practice being brief; and communicate, not just talk, communicate!

 

© 2013 Roger Hunt

 

Roger Hunt, Boston Graduate School of Psychoanalysis (regorhunt02052@gmail.com)