Care giver's reaction after covert action

Abstract

Using the metaphor of confession in Christianity, this article explores the dilemma of a care giver in handling a non -compliant patient; suggests a solution by legalizing covert medication.

This is in response to “Covert Medication in Psychiatry: A Case for Taking it Out of the Closet and Using It Rationally, Without Being Apologetic.” By A. K. Kala

This is not a Review in the conventional sense. It is a Confession.

“Father I sinned. Yes. I did.”

“…. and what is the sin my child?”

“Father, I had to give medicine to my son without his knowledge for one year. He refused to accept that he had a problem. So I consulted a government psychiatrist and discussed the issues on hand. He said that there is nothing unusual about it because many with mental problems do not accept it; less so to meet a psychiatrist.” Saying that, he prescribed a medicine called Espazine (if I remember correctly 20 mg?). He also added that “the dosage may not be correct because I have not seen the patient. But it will at least keep him under control.”

“…….. So this continued for a year and showed some progress. But the overt medication was homeopathy and my son was convinced that it was the solution. “But, Father, this continued for one year.”

“…..until one day there was a breakdown; unfortunately it proved a blessing to get him admitted. Then the treatment began. Very soon, it was realised that 20 mg was not only inadequate but he may have some other disorder – other than what Espazine can handle. The doctor said that did not prescribe more for fear of the patient suspecting something and of course we believe anti-psychotic are best to arrest violence and deterioration.”

“But Father, my only consolation is that the moral support came from the psychiatrist. Also, once the treatment started, myself and my late husband decided that we should disclose the sinful deed. Why disclose, you may wonder. Not for ethical or moral reasons Father; more for practical concerns of regular visits to the psychiatrist. Hope you understand. Am I forgiven?”

INTERLUDE

Gandhiji has always maintained that Ends do not justify the Means. I agree with him on all issues except coping with mental illness in the family. We cannot let our beloved kith and kin languish. Gandhi did it for his wife and confessed it too. That is why he is a Mahatma. I am not Gandhi; and I do not pretend to be one. But perhaps I must be applauded for bravely disclosing to my son that for 1 year he was a victim of surreptitious treatment and surreptitious prescription. His reaction took us by surprise. He gave a warm hug to us and thanked us for saving him!! Father

“Father my Son has Forgiven me”

POST SCRIPT

There are two important points I agree with Dr. Kala and I quote.

“The Indian Psychiatric Society should accept the fact that because of ground realities, covert medication is used fairly commonly and should lay down the situations where it can be used and should prescribe safe guards, when it has to be used. Owning up the practice, discussing it openly in academic sessions, publishing research about the practice and regulating the practice is the only way to get out the current atmosphere of denial and shared silence. This would also curb its misuse.”

The above fatwa is urgently required to ensure that the present practice of covert medication operates within a framework of medical ethics. It is therefore in the supreme interest of all the stakeholders if IPS can formalize it with protocols. Further, it needs to be given a legal backing with abundant caution to avoid misuse; and abuse of user rights. The Law can also probably spell out a timeframe to withdraw this provision as and when psychiatric services are available as Outreach service across the country.

I do not agree with Dr. Kala in his observation

“May be all stakeholders (especially patients/carers/general public and also professionals) need to debate whether we deal with covert administration of medication by using ethical principles (with necessary variation in practice that follows) or legislate whether it is right or wrong.”

Time has come for IPS to stop academic debate on covert medication and spearhead action.