Risk/reward and dopamine

Here is an e-mail I sent recently to Chris's psychiatrist, Dr. Stern. I based my concerns about the continued use of the meds on the dampening of dopamine levels to suppress anger and anxiety while simultaneously suppressing the risk/reward incentive.

Dear Dr. Stern,

The concerns I expressed about the medication suppressing the risk/reward incentive I think is very real. While Chris seems very stable in many ways, he lacks an enthusiasm and a willingness to stretch himself. I am puzzled why he is content to continue to audit one course at a time at university, rather than jump in for credit. Ian and I have not been pushing him in any way, just the opposite. We are letting things go along at the pace he wants to set. But, he is 26 now, and time is moving on. Leading a fuller life requires being willing to take some risks.

I don't want Chris to become a perpetual patient and that is a risk that is very real the longer he continues with the medication. Already, because of the Serdolect (a drug I never wanted him to take), he has to check in with his family doctor to have ECGs. This is keeping him a patient by adding new medical visits to his schedule. In one week recently he had two appointments with you, one with Dr. XXX, and one with Dr. YYY for the ECG. I am all in favor of the work you are doing with him and twice a week is fine as long as you feel that greater progress is being made, but I am not at all in favor of adding medical complexity of more doctors and unnecessary medical tests.

Dr. XXX is connected with a program that I wanted to extract Chris from because the program failed to deal with the root cause of psychosis, offering instead a biochemical view of mental illness that didn't help Chris for the two years that he was enrolled in the program. I feel that our wanting to meet with Dr. XXX and her chief threatens the program's established view of mental illness as biochemical. This view is rapidly becoming out-of-date due to many recent published articles and books that question the efficacy of medications to treat mental illness and that look once again at mental illness as a logical reaction to pain.

I am sharing my concerns with you because I think you share to some degree the points I am raising. I do not have confidence that Dr. XXX and her boss feel to the extent you do that there is a time limit to medication. I hope they prove me wrong. I have been thinking, but have not mentioned to Ian, if we could eventually trade Dr. XXX for a private psychiatrist to monitor the meds (and work with you to reduce/eliminate them when the time comes). I know that you don't want to be side-tracked by focusing on meds when you see Chris, and you like the idea of a second person to handle the meds. A private psychiatrist would be more open to working with the desires of the patient, instead of imposing the thinking of the institution on the patient. I have never met Dr. XXX, but know the program she is involved with.

These are my concerns which I thought I should share with you before we meet with Dr. XXX in the near future.

Best regards,

Rossa Forbes