Your Family Really Can Kill You

Only 16% of all murder victims are members of the defendant’s family?

That’s according to the PDF file that pops open (or opens in your browser) when you click this link – and you must have the free Adobe Acrobat reader to see it. (Fortunately, it is included with most computers nowadays).

Actually, I am surprised to see the number is so small.

I am a little bit heartened to learn that only 20% are strangers.

This leaves 64 % that are friends and acquaintances.

Why am I heartened? Because maybe, just maybe, (at least) 64% of the time people may actually have at least a little control of their lives.

At least a little control over their own ability to escape a murderous fate.

After all, it is (classically) said that you pick your friends — although it generally seems acknowledged that you cannot pick your family.

But me, I am not even convinced so much of that.

I have several people in my practice right now who are not responding to antidepressants the way I would want them to. I am reviewing the literature because this is a treacherous world and I am in a gray area here.

There are a few older proven “augmentation” techniques, of which the best proven and the best known are the adding of lithium or of some thyroid hormone to the antidepressant.

NOTE: Don’t try this at home! I know how to do them, of course, but they are not completely without risk. Ask your doctor if you absolutely think you need this type of intervention – but TRUST your doctor!

Lithium is more of the risk for the older patients than the younger ones. I like, often, to get an electrocardiogram (EKG).

There are plenty of types of thyroid hormone, and it can affect various organs in various ways.

Don’t buy it over the internet! Don’t try this at home! Medicine isn’t Do-It-Yourself!

I have always thought that the best thing to do in real life (and much safer) was to add on some psychotherapy. People got to learn to cope with the life events that are associated with their depression in the first place.

This was easy to do in a university setting with trainees chomping at the bit to take new cases.

This is harder to do in small-town rural California where most of my career has been.

So I was blindsided by a realization.

Every single patient with whom I am currently struggling to make the antidepressant do its job has a serious family problem.

I mean serious.

I can think of exactly six of them while I’m just sitting here comfy on the sofa in my jammies (when I probably should not be thinking of work in the first place) and every one of the six (all women) is in a horrible sort of never-never land that involves weighing the merits — generally few — of preserving a destructive, even abusive relationship, against being alone, most often accompanied only by dependent children, in what is perceived as a very hostile world.

My mandate is not fixing their family units. I am supposed to treat the “neurovegetative signs” of depression in the individual sitting across the desk from me.

I want them to be eating properly, getting enough sleep, paying attention to work at work — stuff like that.

And these basic, prerequisites for life in the universe are so extraordinarily compromised that I am at the very edge of cumulative psychopharmacological knowledge, in my own never-never land of trying to reason rational prescriptions from my theoretic knowledge, with no real medical applied science to help me.

I have to wonder what a given substance will do to the transmission of a given set of brain cells, with only that knowledge and anecdotal reports (and prayer) to guide me on guiding them out of an unspeakable bodily misery, where they feel denied of some of life’s most basic functions.

This is what I was trained for. This is my specialty. A family practice doctor or a nurse-practitioner or a physician’s assistant dishes out over 80% of psychiatric drugs in these United States (thanks to “cost-cutting” medical insurance mandates) – and they have no idea of what happens to the person when they take the pill – or what happens to the pill once it goes into the body.

Perhaps my most valuable advice comes not from science, but from the experience of having guided too many people through this.

Drugs aren’t always the answer —

Although I cannot do a good job of proving it from any kind of a medical journal, I have seen lots of people in painful and/or abusive relationships get better when they end the relationship.

I can’t find this in the literature because, like most of the problems I see in life and my ideas for doing research on same, it falls between the cracks.

The cracks between disciplines. Between medical specialties.

Those limited-scope regions of human endeavor that make life easier for people in highly sophisticated academic institutions, and harder for real life.

Those limited-scope areas of medicine that have been artificially carved out instead of looking at the “whole person” – where the one-hand-washing-the-other belongs to the same doctor!

That is why it took until 1979 for researchers to show that people with better social connections stay alive longer. (The citation isn’t handy, but I can find it again if you need me to.)

The people who are studying what makes people die (public health, medicine) are not the same as the psychologists or sociologists who study social connections.

The pharmacologists who do things like review all the medications you can add to antidepressants to make them work better are not the same as the folks (psychologists or sociologists) who look at destructive relationships.

To me, it has been staring us all in the face for a very long time.

If you feel the way someone close to you behaves “”makes” you “sick,” my guess is that it does.

This does not mean that all such relationships should be terminated. There IS scholarly literature that shows such therapy works.

But any family therapist worthy of the name — including the one who supervised me during my training — would admit if the commitment to remain a family is not there in the first place, the marital or family therapy is not terribly likely to succeed.

So you gotta know when to stay and when to go.

Friendly relationships seem to be, and to always have been, more powerful than anyone wanted to believe.

Just know that, in general, you have more control than you think.