Saturday, May 13, 2017

CMDS 2017 - Psychiatrist Meeting

At the CMDS Conference there was a meeting arranged for psychiatrists to discuss the new euthanasia legislation.  We had several practicing psychiatrists, retired psychiatrists, missionary doctors and a couple of new residents.  Concern was expressed by all who noted that when people are suicidal they are most often not in their right mind to be making a life and death decision. Further if they are given the option of suicide then they can cling to that without consideration of alternative simply because it is a drastic permanent solution to what is most commonly a temporary problem.  The residents stated that it was already being discussed with patients as a potential option.
The psychopharmacologists present, especially the older ones, listed countless cases of patients who presented suicidal because of untreated psychiatric illness whose suicidality stopped once their mental illness was addressed. It was such a common psychiatric practice and all had observed that a new medication could be literally life saving.  Of those present several commented on observing this just recently with the latest of our medications for depression and anxiety, TRINTELLIX, PRISTIQ and ABILIFY.  Patients who had previously had no relief experienced this with a change of medication and almost miraculously they stopped being suicidal. Their lease on life was restored.
Emotional pain was discussed as similar to physical pain. and Once the emotional pain was addressed hope was restored. There was further the idea that suicidal thoughts were common in the general practice and especially in the psychiatric practice but the obsession with suicide and suicidal behaviour could often represent psychotic thinking.  Again once the psychosis was treated the obsession to suicide lifted.  Everyone had seen such cases and expressed concern with the new almost beurocratic approach to death appearing to encouraging suicide.
There was also discussion of various psychotherapies which had worked to shift a patient from negative thinking to positive thinking. Cognitive behavioural therapy and paradoxical interventions and now dialectic therapies all have been shown again and again to cause a patient initially suicidal to simply rethink their options, choose life and move forward. The original psychoanalytic approaches still worked miracles.  But every year there  major advances in the potential psychotherapeutic approaches to the treatment of mental illness and especially suicidality.
Everyone present had known a suicidal patient and seen the devastation that suicides caused for the families and friends who felt helpless and seemed invariably to think that of it as the ‘wrong’ decision, ‘irrational’, or 'premature'.  Yet the patient often presented 'as rational' and so often insisted they had really thought of or tried all options which we as psychiatrists most often saw was simply untrue.
There was a sense too that this paralleled the abortion issue which had similarly begun with extreme outlier examples and lots of mobilization of public support and moving quickly to  the present state of the most lucrative abortion industry with its powerful financially invested lobby.  How long would it take before psychiatrists might face being arrested for not encouraging euthanasia.  Further given the financial realities of child rearing costs in Canada, increasingly abortion is forced on even the middle class. To call it ‘choice’ is a joke when in Toronto and Vancouver professionals with two incomes can’t afford a house and often barely manage to manage with prohibitive taxation. How long before the 'choice' of euthanasia is similarly forced on individuals. That certainly was the case in Holland where the older depressed patients were getting euthanasia rather than psychiatric care.
I especially liked the youngest person present who said , “I don’t like the euphemism, MAID. It’s euthanasia. I think my generation isn’t as stupid as the politicians think that they can candy coat a thing and eveyone won’t recognize it as euthanasia."
Personally I was thankful to be with other caring clinicians. I’ve been devastated by many suicides working in the highest risk populations. In this fentanyl crisis I’ve had several young patients overdose. Frankly I’m not sure if this wasn’t suicide given the increasingly callous disregard of the mentally ill and marginal by the privileged elite of our society.  Increasingly I feel that my patients aren’t wanted. I am thankful for the Christian Medical and Dental Society because the clinicians, especially my colleagues in psychiatry, demonstrate such compassion.
We also discussed the pseudoscientific positions  the increasingly aetheist authorities misuse and misrepresent science mostly to increase taxes and reduce services.  There just aren't enough resources for the mentally ill, not enough acute or chronic beds and not enough psychiatrists or recovery options.
As clinicians working in the field of psychiatry in Canada most of us really feel we need spiritual solace in dark times.  Being with these colleagues I remembered again that I must never forget that Jesus was a healer.  I personally can solace in the Lord and comfort in the fellowship of faithful healers.
Praying with fellow psychiatrists was the highlight of my trip.  Thank you Jesus.

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