Robert R. and I are having a disagreement about psychiatric medications, i.e., drugs. He thinks they are pretty good and I think they are terrible. We are having this discussion via the miracle of social networking via the Internet, which is not all it’s via cracked up to be. Robert and I live about fifteen hundred miles apart. We know one another’s words; we know next to nothing about the context which has birthed those words.
Robert is a clinical social worker for people with mental illness; I am an activist for social rights for marginalized people. Robert and I are both pretty smart and old enough to have a lot of experience. Robert is also an attorney. He appears to have spent several decades practicing law—those same decades that I was taking psychiatric medications. He is atypical—one might say extremely atypical—in that he changed career paths from law to mental health. I am also extremely atypical in that—after twenty-six years—I stopped taking antidepressants. Robert lives in Louisiana and I live in Central New York.
So let’s talk about the impact of geography, industry and the law on the prescription of antidepressants.
The closest I’ve ever been to Louisiana was Palm Beach, Florida. I would bet that Robert would smile, shake his head, and say, “The two places are nothing alike.” I’d be willing to believe it. I’m guessing that Robert isn’t aware that Syracuse, which is located as the bellybutton of New York State, averages ten feet of snow each winter and has less sunshine than any other city of a similar size. Our winters are long and dark.
The darkness causes seasonal affective disorder, which is a form of depression resulting from lack of sunlight. The snow and cold—the temperature drops to below zero—force us to isolate in our homes. After work, we do not play a round of golf or a couple sets of tennis; we often go to bars. Not too many years ago a police officer had the misfortune to pull a man over for driving while intoxicated. The driver was the chief of police, who had just left a bar. His traveling partner, also intoxicated, was an assistant district attorney of the female persuasion, and not his wife.
Shall we call the man immoral, or should we note that he sought escape from depression in wine and woman? If he had gone to a psychiatrist he might have been directed to get a full-spectrum lightbox; more likely, he would have been prescribed antidepressants. Central New York is very conservative—surviving a wind-chill of -12 degrees in a white-out with snow blowing sideways requires high-level conservation skills— and a lightbox would be considered an “alternative medicine” and therefore liberal and highly untrustworthy.
It is a hard life up here; we are lonely and sad for long periods of time. That is a fact of geography, so what does industry have to do with prescribing antidepressants?
Our major industries used to be General Electric, General Motors and Carrier Air Conditioning, but they have all moved out, whether staying on-shore or going off-shore. Our three biggest employers now are the county government, Syracuse University, and SUNY Upstate Medical University. “Upstate,” as it is known locally, is part of the State University of New York, and an enormous teaching hospital—at least it is at the moment. There are an increasing number of news reports that it’s been placed on an academic “failure to thrive” list, and that various physicians are charged with committing or defending against various practices that are illegal, immoral or both. (See also the pediatrician molesting young boys and the physician run out of town on a rail when he reported surgery taking place without an appropriate surgeon in the operating room.)
Most of the citizens either work for Upstate or have one or more significant family members or friends who do. When we criticize Upstate, we do it in hushed tones lest our familiars be offended. Many of us find much to criticize about Upstate. Patients are often told—by the lower level staff members with whom they have the most contact—that Upstate exists “to train doctors.” The implicit corollary is that Upstate is not in business to treat patients, and it acts like it. Good patient care is not a practical priority. Patients are not treated with respect.
A metaphorical representation of Upstate’s relationship with its patient-base is this: A subsidized high-rise apartment building that used to house poor people was purchased by Upstate and is being renovated into upscale housing for medical students. Students who have yet to earn a living will be given superior housing than the poor—many of whom were impoverished because they were too sick to earn a living. Make way for the doctors and the patients be damned.
The infamous “studies show” (I forget the exact statistics) that the majority of physicians go into practice within fifty miles of where they complete their training, which means that the greater Syracuse area is inundated with physicians who were trained by conservatives of questionable morality and intellect. Likewise, the area is replete with citizens who depend on the hospital for employment, and trust the doctors as the gods who will relieve them of their suffering.
A couple other things worth noting: first, another significant employer in the area is Bristol-Meyers Squibb, a pharmaceutical company (see also March 6, 2012, Bristol-Myers Squibb Announces Dividend). Second, two physicians—Dr. Charles Gant and Dr. Jennifer Daniels –were accused of practicing alternative medicine and driven out of town.
I live in a geographical area that creates isolation and despair. It also is strongly influenced by overwhelmingly conservative medical practice. In other words, we get depressed and are told to take antidepressants. (To be continued)