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The ethical and medical black hole that is covert medication
ADITYA MANI JHA  3rd Aug 2013

A still from The Marketing of Madness, which questions the efficacy of psychiatric medicine

n India, when we talk about covert medication, we're mostly talking about patients suffering from bipolar disorder or schizophrenia. When such a person is not in a position to harm himself or others, we do not force medication on him." Dr. Anirudh Kala, the first speaker of the evening, is hitting all the right notes in his measured, diplomatic speech. The panel has three psychiatrists (Dr. Kala included) and a lawyer. The discussion is titled 'Of good intentions and doctored omelettes', about covert medication in Indian psychiatric practice.

The air-conditioned stillness at the India Habitat Centre is making me a little numb, like how certain pills can make you feel once you give 'em time.

Dr. Kala and the rest of the panel is concerned that most psychiatrists — or psychiatric societies — do not discuss covert medication "even though it is a common practice". So common, in fact, that the two doctors on the panel following Dr. Kala both admit to having "personally administered covert medication" to ailing family members. When Dr. Kavita Arora begins to talk about a chronically ill family member, I realise that my compulsive finger-tapping is suddenly, painfully loud in here. This is the stuff which regular folk talk about after watching four or five House M.D. episodes back-to-back. Where is the sense of responsibility? What about the patient's rights? Who cares about the family who've been going through the same cycle for years, sometime decades? Why don't the doctors and the family join forces and assume collective responsibility?

"The implicit act of prescribing medicine is saying, 'I believe so-and-so person will benefit from this'. I accept that covert medication exists and this acceptance is the first step. Why do we not agree with it in totality? Who's the person looking at the patient and deciding, 'Today is a dangerous day'?"

Stories unfurl during the course of the evening. Through them, I see the doctor, who slipped her erratic husband (also a doctor) anti-psychotic medicine for months. ("Initially, there was some suspicion over the taste of the tea.") When she returned after a month-long trip, her husband's symptoms were back; extreme mood swings, temper tantrums. Within two months, he had picked up an alcohol habit, for which the wife now blames herself. I meet the Tagore-quoting Dr. Anup Dhar, who's no stranger to these chai-centric tactics himself. "There's a covert aspect to even non-covert medication," says Dr. Dhar.

Where is the sense of responsibility? What about the patient’s rights? Who cares about the family who’ve been going through the same cycle for years, sometime decades? Why don’t the doctors and the family join forces and assume collective responsibility?

I understand Dr. Dhar's point better when Arjun Chawla, seated in the last row, raises his hand and begins to speak about his ordeal, which lasted over a decade. Chawla is a strapping, earnest-looking man in his early thirties. His story is indicative of just how muddy the waters are. In 1999, a horrific accident left Chawla in a coma for two months. He was diagnosed with clinical depression in 2001, and promptly prescribed "anti-depressants, mood stabilisers, you name it." But not one doctor — and he would go on to consult many — in the twelve years from 2001 to 2012 thought it fit to inform him about the possible side-effects of the drugs he was on. Throughout this time, Chawla struggled with insomnia and sexual dysfunction. "What do you think that did for my self-image?" he says, to murmurs of approval. After Chawla's impassioned narrative, the lawyer in the panel is looking like the person with the only worthwhile answers. ("An act of good faith on behalf of a person unsound of mind cannot be condemned by a court of law, unless said act results in death.")

A few days after the event, I call up Chawla, looking to fill in the blanks. How did he break out of the drug cycle and when? "Around 2008, I was living in Germany and I got quite sick and tired of the medicines. I researched my symptoms and my medication online. The doctor would simply tell me that I have a 'chemical imbalance' in my brain." Chawla stopped taking Oleanz (the anti-psychotic he was on), and his constant drowsiness and exhaustion subsided. But his ordeal was far from over. In a bizarre turn of events, Chawla's penchant for researching his condition found the most unexpected of opponents — his then-doctor, Dr. Achal Bhagat, who heads the Division of Mental Health and Quality of Life at Medanta.

Chawla, during one of his routine visits to the doctor, showed a video to Dr. Bhagat's consultant Maneesha. The video listed the different ways in which certain psychiatric medicines could hurt you. Maneesha went into Dr. Bhagat's chambers, and presently, she stepped out and informed Chawla that the doctor was ready for him.

"The first statement that came out of his mouth was 'Arjun I can't treat you anymore'. My mother was in the room. She had been accompanying me to the doctor's, afraid of my temper, afraid that I'd blow up. I just smiled at him (Dr. Bhagat)."

Should an enterprising soul place an egg on my forehead right now, he or she has an outside chance at a tolerable omelette.

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