Are We Governed By Nature Or Nurture? Big Pharma Says It Should Be . . .

Smiling Politician

“I don’t trust people who smile all the time and I don’t trust anyone who suggests that I should trust them.”–jc

Years ago when I first became interested with the ‘nature vs. nurture’ debate I was fascinated to see how many folks believed that behaviour and such was completely driven by the nurturing aspect of our lives. The researchers and the scientists said that parents and society were solely responsible where ‘little Billys’ behaviour was concerned. But then numerous studies were undertaken to show how boys played with trucks and girls played with dolls if left to their own devices and that’s the way that nature had planned things. Case closed. Then supervising people such as parents and/or other care givers were asked to switch the toys and reward altered choices, interests and behaviours and so on. This was supposed to prove definitively that behaviour was nurture driven.

Fortunately or unfortunately, depending upon how you look at it, the pharmaceutical industry has really taken over the drive to make some sense of this whole debate. They have the money and the expertise to do it but they have proven themselves to be untrustworthy at the best of times and selfish beyond compare. Have they funded or been responsible for amazing breakthroughs? They sure have. Have they put out huge sums of money? Yes they have. They have also profited in a huge way. I understand wanting to recover the costs of research and development but immediately upon release? One begins to question the presence of an ulterior motive? I doubt that pharmas’ generosity is strictly about benevolence. What of those who can’t afford thousands of dollars a month to stay alive? The rich can pay but the poor can’t so they die? Not a great social business model. But there they are standing out in front of us on TV every day extolling the benefits of the newest drug to hit the market with a list of side effects as long or longer than the symptoms that will be relieved when you take their medication. It is all presented to us by folks with big happy smiles on their faces asking us to trust them and their latest concoction. I find it difficult to trust anyone who smiles all the time now. My first reaction is ‘what are they hiding?’

The pharmaceutical industry has always been involved in the addiction/mental health debate. For years the two camps have managed to stay clear of each other in terms of treatment modalities, theories, approaches and funding but with shrinking budgets in the health care field the need to save money has become the driving force in the type of treatment that clients receive. The debate is now driven by no other reasonable hypothesis. For the last few years the move has been to ‘combine’ the two fields and thus save a great deal of money on duplicate services, office spaces, office staff, less need for ER services–now it’s called ‘urgent care’. You may have an urgent need but that doesn’t translate into receiving urgent care. Good luck with that one.

I will admit that when the debate about whether or not mental health services and addiction services should be amalgamated into one ‘umbrella service’ I was on the side that said that does make some sense certainly from a fiscal point of view. Having worked for a lengthy time in the addiction services field I have changed my mind. There is the chicken and the egg thing going on here that is becoming more difficult to reconcile especially with all the ‘new’ medicinal treatment options available for our mental health clients. Does someone have a mental health disorder and then start to abuse drugs and alcohol because of that disorder or does the disorder ‘develop’ because of the alcohol and drug use? The DSM, which is the ‘bible’ used by psychiatrists to diagnose mental health disorders has grown substantially over the last ten years and now includes an addiction as being classified a mental health disorder. There are pills now to help alleviate some of the symptoms. The point is treatment for an addiction is becoming more of an issue to be treated by taking a medication than a problem that can be treated without the use of medication and have as much success. Do we treat the disorder and then the addiction or the other way around. Some say both at the same time but that troubles me some because that means that a client is trying to get used to a new medication that may of may not work well and at the same time we are expecting that client will be able to remain abstinent. Well if he could remain abstinent he wouldn’t need to be treated with medication for an addiction. If he/she uses alcohol during the time they are taking their medication for the mental health disorder that, in itself, poses a serious health risk. The other question is how much of the ‘mental health’ disorder is created by the stress, anxiety, lack of sleep and trauma caused by the substance use and would it begin to dissipate if/when the use was dealt with successfully?

These are questions that have no clear cut answers as yet. I don’t believe that we need to be making judgements regarding the quality of peoples lives without more substantiated proof beyond the acknowledgement that it makes fiscal sense and therefore we should do it. Pharma should not be the driving force. Obviously their influence in the debate is tainted a bit by their desire to have it become a medication based treatment approach. I would like to see a day when treatment for mental health disorders are treated chemically, if needed, and the addictions component is treated using a CBT-Cognitive Behavioural Treatment approach meaning more Life Skills Training and behaviourally directed approaches with less chemical intervention. But the system has been there and the pharmaceutical/medical field didn’t want to stay there so here we are with neither side of this getting anything close to what they really need to make a difference in the quality of their lives. The focus needs to be on functionality and not just existence and symptom management.

So when management comes to you with a smile, asking you to trust them and they are talking about encouraging transparency (it has become another word for duplicity) in the system, be sure to check your BS meter before jumping in.

Anyways, that’s how I see it–Jim

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