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Heal Thyself

As a psychiatrist, I was deeply disturbed by the "First, Do No Harm" story by "Tory" [Aug. 9]. First of all, there's no excuse for any physician, especially a psychiatrist, writing a potentially addictive drug to a recovering addict except under very special circumstances, and certainly not on the first meeting. But just as important, there's no justification for a recovering addict, let alone a social worker with training, to accept a prescription for an addictive substance.

In her story, Tory tells the doctor this, yet accepts the prescription. In Tennessee, there's a doctrine called comparative negligence that says if the patient is more than 50 percent responsible for the negative outcome of treatment, there is no malpractice. I'd hazard a guess what a jury would think about Tory's part in this debacle. Next she attacks her previous psychiatrist for dismissing her for two no-shows. Whose fault is that? Then she discovers that psychiatrists are in short supply, especially in Knoxville. I, too, have closed my practice to new patients. Would she have me take on every caller and thus become another "drive-in" shrink with 5 minutes rather than 25 to 50 minutes to spend with each patient as her "good" psychiatrist did?

Why didn't she check into rehab immediately when she realized she was abusing the Xanax? And finally, the last psychiatrist did exactly what the previous one did, wrote her a prescription for another potentially addictive tranquilizer, Tranxene, yet she idealized him and actually followed the directions! Assuming what occurred is the truth and not distorted, the proper response would be to call the Tennessee Board of Medical Examiners and report the doctor prescribing the Xanax. Then, 18 months later when the overworked and underpaid staff gets around to investigating the doctor because the Tennessee Legislature doesn't think the medical board needs much money (would it surprise you to know that Tennessee ranks dead last in disciplining doctors?) to investigate doctors, someone would demand that doctor account for his stupid actions. As she admits in her story, addicts con doctors, and the doctor's side of the story could be quite different.

Anyone prescribing potentially addictive substances takes that risk. We cannot quit prescribing beneficial medications just because a certain number con us. If Tory was deathly allergic to Xanax and prone to fatal anaphylactic shock, I truly doubt she would have taken that prescription to the pharmacy. She points out addiction is a fatal illness. She knew better.

Lane M. Cook, M.D.
Knoxville, TN

Taking 'It' On

I have just read your [Aug. 9] "First, Do No Harm" article and found it to be an excellent, insightful and mostly honest piece recounting a woman's personal experience with addiction and mental illness.

As one intimately associated with the mental health field, both as an administrator and recipient of care and services, I am well acquainted with the problems and issues highlighted in the article.

When I began the article, my first response was my usual one to such mental health exposés; anger, sadness and disappointment. Many themes and events were easily recognized. First, while some names were changed or omitted, I was easily able to identify several patients and professionals by name and facility as my own coworkers and those we serve. Secondly, I hear this story over and over from addicts: This isn't my fault. The doctor prescribed them for me.

Tory was able to accept her role in her relapse, but unfortunately, this is frequently not the case. Cross addiction is a fact that will inevitably lead to relapse. Lastly, the cold and incompetent picture of mental-health facilities and practitioners as portrayed in the article is only partly accurate.

I wish that I could say that all health-care givers were kind, compassionate, competent persons. Sadly, I cannot. I am sorry to say that I have seen doctors and other practitioners inappropriately prescribe and administer narcotics and psychotropics. On any given day any of us in the field may fall short of being ideal caregivers, but all too often the situation is cast in an us-versus-them light. It is particularly ironic when one becomes aware of the fact that many mental-health-care providers are also recipients of these same services. As care-givers (and at times over-extended and under-appreciated care-givers), it is our responsibility to consider the consumer and perform better than our best ability.

I am grateful that Tory was not only able to begin recovery but to find a practitioner that meets her needs, since an addict, particularly a recovering addict, must be cautious and assertive when dealing with a health care provider. I pray she's able to find and maintain peace. There are those practitioners out there who are similar to the ones Tory described: cold, inattentive, and hurried. However, there are others who reach out with a caring but strong hand. Thank you to Tory and the Metro Pulse for reminding the community that mental health illness and addiction is not an us-versus-them issue, but is and always will be an all-of-us-against-it fight.

Summer Brown
Knoxville