4 To medicate or not to medicate?
Although there has been a considerable reaction to the routine use of anti-anxiety medication for people presenting symptoms of complicated grief, the practice remains common in western societies. Joan Cook and her psychiatry colleagues (2007a, 2007b) interviewed doctors and older people in the USA to find out how people in both groups dealt with bereavement. She found that many of the doctors usually prescribed mood-altering drugs such as tranquilisers because of a compassionate sense of wanting to do something to help. On occasion, however, they also prescribed medication as a formulaic response for their own convenience:
A benzodiazepine becomes a quick fix because you don't have time, this is what they want, they don't feel good, here it is. It numbs them up and you're not gonna get a phone call afterwards, you're not gonna get anything, you'll see them in a month, here's your renewal, see ya later.
(Cook, 2007b, p. 305)
The following comment from Cook's research was quoted in the health pages of the New York Times website.
People who call me up and say my son died, my husband died … I would give that [the anti-anxiety medication] to them in a flash. Fifteen pills, twenty pills, a month's worth, of course. If this isn't enough, you should make an appointment and come and see me. So they're wonderful drugs for that.
The report of this research on the website sparked a lively web-based discussion in which people provided moving examples from their own experience of doctors who have used, and possibly misused, anti-anxiety medication for the treatment of grief reactions.
Activity 4: Tranquilising grief
Read the two excerpts below. They are taken from the above-mentioned web-based discussion.
After you have read the extracts, make some notes about your own feelings about the use of tranquilisers for grief. How would you like to be helped through a period of grief that you might experience in the future? Do these extracts relate in any way to your own experience?
The only way to deal with grief is to deal with grief. Medication may ameliorate the symptoms without touching the underlying causes. People would wind up addicted and stuck in their grief. Those who grieve need to understand what they are dealing with and unfortunately there are no shortcuts.
Posted by Chaplain Barbara Sorin, 10 October 2007
When he passed away, I found myself in a situation that I was nearly friendless, except for Lilla, a wonderful friend of many years, with whom I could share my feelings. Lilla died in June. Another friend was murdered a week later. So, as a result of my husband's cancer, we saw our friends dwindle, and when he died, and Lilla died, I've been left without him, without my circle of friends for comfort and support, and very few people who want to sit with me while I go through all of the feelings, sadness and grief I feel. I try to stay even-minded, and if it weren't for Paxil [an antidepressant] and Xanax [a benzodiazepine tranquiliser], I don't know how I could function. I work full-time, and getting time off from work for therapy is impossible. So what are the grieving left with in the real world? If I felt every emotion I have, I wouldn't be able to function! Get real, get off of our backs, we feel like crap, we can't just ‘get happy’ or grieve according to your schedule. … Meds help, meds make it possible to function, and keep a cap on how much emotion is dealt with at a time. It might take longer to grieve, but the crippling feelings are kept at bay, and I can function, I can find joy in my grandchildren, and I can be strong enough to answer their questions about grandpa's death. Give people a break! No one solution will work for every person's situation.
(Online comments on Parker-Pope, 2007)
The debate about the use or non-use of medication to help with grief raises a series of complex issues and, as demonstrated in the exchange above, can involve very raw emotions. For some people, grief is an ordinary part of the human condition, implying that it is something that people ‘naturally’ have to experience. However, people experiencing grief might find this a difficult, an impossible or even an unnecessary challenge. Why make things even more difficult if there are pills to ease the process?
Certainly, tranquilisers are very commonly used for a wide range of anxiety-related problems, including grief and other symptoms associated with bereavement. The most common type of tranquilisers are part of the pharmacological group known as benzodiazepines. You might be familiar with these from their popular, commercial names: Valium, Librium, Ativan, and so on, or know them by their pharmacological names: diazepam, chlordiazepoxide and lorazepam. They are used widely throughout the USA and Europe, where 2–3 per cent of the general population have been found to be taking this form of medication. This is despite the well-documented disadvantages of their long-term use (Voshaar et al., 2006), which include ‘hangovers’, memory impairment, emotional blunting, tolerance, dependence and an increased risk of falls and road traffic accidents (Chouinard, 2004).
So why do doctors prescribe benzodiazepines? A Belgian sociologist, Sibyl Anthierens, and colleagues (2007) asked 35 general practitioners in Belgium why they continued to prescribe benzodiazepine medication even though the adverse effects are so well known. The doctors seemed to be aware of the problems associated with the use of benzodiazepines but considered that prescribing the medication was the lesser of two evils. They also reported feeling overwhelmed by the psychosocial problems, such as grief, brought by the people who came to consult them, and they tried to demonstrate their empathy by writing out a prescription. Many of the doctors also felt that there were no practical alternative solutions available to them, or their patients, and that time constraints often led to them issuing prescriptions. Similarly, one of the American doctors responding to the New York Times article discussed above thought that pressure from people experiencing emotional difficulty and their families was a significant factor when deciding whether to prescribe medication or not:
As a physician, my dilemma is how to respond and help the patient (and bereaved family) asking, or even insisting on these medicines for the elderly after a significant loss. What response do we give without sounding cold hearted and accusatory – e.g. ‘you see your mother might fall or get addicted… she cannot handle this medicine’. It is a tough line to walk. No doubt physicians operate from compassion but also are responding to specific requests from the bereaved and their loved ones in many instances.
(Online comment on Parker-Pope, 2007)