Dr. Drew Pinsky notes "there were a number of factors" that contributed to William's condition. He states "alcoholism is certainly one. He may have had a genetic potential for depression. Addiction and depression can be an easily fatal combination." Non-sequitur.
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Depression needs to be treated by thoughtful, educated, competent and trained experts in depression not self-declared experts. ASAM doctors are not "real" experts. They are pretend experts trumpeting one frozen paradigm while dismissing or ignoring others. It is expert opinion where the goal is not new knowledge and and new discovery. Th die is cast. And most of the "research" put out by this group consists of methodologically unsound studies published in their journals in which an attempt is made to make the data fit an already determined hypothesis.
Point being that depression needs to be evaluated and treated by trained professionals who understand depression. Psychiatrists, psychopharmacologists, neuropsychologists, and psychologists schooled in a broad spectrum of treatment modalities. Numerous depression treatments are available and if they are ineffective then sub-specialists need to be brought in. Most depression is treatable, especially subacute or acute depression. SSRIs, SNRIs SNDRIs, tricyclics, MAOs, and atypical antidepressants are available. Different types of psychotherapy are available--cognitive behavioral therapy, interpersonal therapy, dialectic behavioral therapy, mindfulness therapy, and Jungian psychoanalysis can be beneficial for people suffering from depression. And ECT and TMS can also play a role in depression refractory to medications and psychotherapy.
Depression is extremely common in Parkinson's disease but due to the dopamine loss it requires special consideration of what drugs to use and not use. SSRI's can sometimes worsen the condition. Consultation with a knowledgable and experienced neurologist is critical.
I do not know what assessments or treatments were being tried in Robin Williams. But the treatment modalities usually offered by ASAM physicians are usually few to one.
The majority of "addiction medicine" specialists are not psychiatrists. For all you know you may find yourself being treated by an addiction "specialist" who was a practicing proctologist just a few years prior; and perhaps not even a good one at that.
Moreover, many of the ASAM physicians are "anti-medication" and may take people off medications that have been helping them and that they need. And the devastating results are often seen after the patient has been discharged home.
Taken off drugs while in rehab and sent home without them, the beneficial effects may wear off gradually. And as they do their mental condition may deteriorate. Manic episodes, paranoid psychoses, extreme anxiety, and profound depression can all occur well after someone has been discharged home. And so can suicides.
And when this happens the ASAM doctors blame it on their fatal "disease" when, just as is seen with the suicides of bullied teens, it was actually they who put the gun to their heads and pulled the trigger.
Depression needs to be treated by experts in depression. Putting someone in a one-size fits all shackled and frozen mold can be fatal. And calling them helpless addicts with a chronic disease who have no control due to character defects adds kindling to the fire. Depressed people need empowerment not powerlessness; self-esteem not shame. Shame is devastating. It goes right to the core of the person's identity making them feel exposed, inferior, and degraded. Dehumanized, delegitimized, and vulnerable. The link between bullying and suicide is clear. And this is especially true when combined with entrapment. The feeling there is no way out.
When society gives power of diagnosis and treatment to individuals within a group schooled in just one uncompromising model of addiction with the majority attributing their very own sobriety to that model, they will exercise that power to diagnose and treat anyone and everyone according to that model. And it can be fatal.
Under a dictatorship everything else becomes subordinated to the guiding philosophy of the dictatorship. Corresponding doctrine replaces ethics as well as professional guidelines, standards of care, and evidence based medicine. Ideology usurps critical thinking. Having only a hammer, everyone is seen as a nail A symphony with one note.
And faith in institutions demands mass adherence to faith in that authority. Direct challenge to the status quo and undermines the publics blind faith. The biggest obstacle is th http://mllangan1.files.wordpress.com/2014/08/images-4.jpeg at this system allows them to throw the normal rules of conduct under the imperative of a higher goal assumed to trump all other consideration.
All of medicine needs to be predicated on competence, thoughtfulness, good-faith, civility, honesty, and integrity. This is universally applicable. All specialties of medicine are required by that specialty to practice evidence based medicine and avoid conflicts of interest except one--addiction medicine. Due to a confluence of factors they have been given a pass.
But the validity and reliability of opinions lie in their underlying methodology. Reliance on the personal authority of any expert or group of experts is a logical fallacy.
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