By Benzion Twerski, Ph.D.
In the treatment field, there are frequent problems with patients who refuse to take their medications or follow instructions. Non-compliance is a clinical issue, and even with medical patients, this can be a complicating psychological factor that has been long recognized. Medical education pays some attention to teaching the tricks of the trade – getting patients to follow orders.
In the growing field of addressing our troubled youth, we encounter our fair share of resistance from those individuals being referred for treatment. What is more overwhelming is the resistance sometimes observed in the parents or family. “I don’t want my son/daughter to go to rehab because ……” “If my child goes away to a treatment program, everyone will find out, and this would ruin another child’s possibilities for a good shidduch.” These are the nice ones, with a reason included. Other parents simply refuse to participate in the process or accept the recommendations of the professional.
The focus of this article is not to berate parents. They have their hands full with a youngster who is acting out. The disruption to daily life is often extreme, and faulting them for misjudgment is neither accurate nor fair. Instead, I see this resistance as part of the problem, and it needs to be addressed as such.
When psychiatric issues are involved and medication is recommended, resistance often reaches a peak, and this is irritating to the mental health professional because it impedes the chances for the patient getting better. There are many prevalent myths concerning the side effects of psychiatric medications. These are mostly myths because of the many changes in psychopharmacology and new medicines that were developed lately. Even many the older medications were not as toxic as the myths purport. Yet, the fears of using medication to be able to function adequately abound, and everyone loses.
A newer problem confronts the treating mental health professional, and my discussion of this is bound to ruffle some feathers. Nutritional supplements are being heralded as solving psychiatric problems. Few, if any, of these substances have been subjected to rigorous scientific research. There is no systematic study that demonstrates effectiveness of these substances, and there is much less than that concerning side effects.
There is a smidgen of research on St. John’s Wart, but wide scale clinical trials that compare it to other antidepressants are yet to be done. There are no pharmaceutical companies invested in these products, hence the absence of large scale research or funding for it. I have always had some difficulty with the passing of advice in the checkout counter in the supermarket or the proverbial line in the butcher shop, but this is a driving force in the use of nutritional supplements. I believe that most of the marketed products have some potency and effect, but I have little or no reason to trust that the claims made for it, by practitioners or on the bottles, have any bearing on the facts.
Having done some ruffling, let me make the application to mental health. I am not a psychiatrist, and cannot prescribe medications. Yet, my clinical judgment, based on training and experience, can lead me to recommend that a particular patient be seen by a psychiatrist and treated with medication. I sympathize with the various hesitancies about taking medication, but that is what works. I am griping, but I am resentful when recommendations are bypassed and the nutrition route followed when my opinion was sought and a competent, best advice given. And it is a shame that this happens at the expense of the patient.
Lest anyone complain that I have challenged others purporting to practice in the filed-to-limit competition and that my above remarks are self serving, let me assure you it is not so. I invite more professionals to this arena. If you’re competent at what you do, anticipate some referrals from me. But if you are not competent, be advised of the following, which I quote from Shulchan Oruch – Yoreh De’ah, 336:1. “Nevertheless, one should not be involved in healing unless he is expert.”
This quote is from the Ramban (Bava Kama – from the Toras Ha’adam). “But this is only with an expert and one who knows the knowledge and skills of this field, and there is no one with greater expertise. However, all who do not have the expertise in this work should not be involved in it….. and if one (without the expertise) is involved in it, he is certainly committing murder.”
Both quotes are my translation, but the references are provided should one wish to examine the original texts. Parents, educators, lawyers, and even Rabbonim do not necessarily have the expertise to decide what treatments should be used. I respect their opinions and hear their wishes, but the treatments that work are all that I can support.
If anyone wishes to dictate treatment, please get the training and experience that it takes to make an educated and expert decision. Otherwise, trust the professionals.