A View From Riggs: Introduction to Paper II “Treatment Resistance and Patient Authority”

Periodically I do a call-in radio show on local public radio. Anonymous individuals call in to ask a psychiatrist questions about psychiatric diagnosis, medications, psychotherapy, stigma, suicide, and other issues, and I endeavor to connect briefly with them, acknowledge their struggles, and then offer a brief commentary in response, always noting I cannot offer treatment advice based on such a brief encounter.

Recently I received a particularly compelling call. “Bob” reported, his voice communicating vulnerability and sadness, that he was a victim of clergy abuse who had struggled for years with depression and other symptoms. The church had accepted his claim of abuse and was now helping him receive treatment. Bob's concern was that, apparently for financial reasons, church officials were pressuring him to use medications rather than psychotherapy in his treatment. He wondered if I had any advice about how to speak to church officials about his sense he needed therapy and his reluctance to take medications. Bob then added, painfully, that the pattern of his abuse had included substances being forced on him by his abuser.

I responded to Bob that I could hear in his voice how hard it was to speak about this. Although I could not weigh in on his particular treatment needs, it was true that medications were often used with benefit in such situations. However, I could also appreciate the way he must experience pressure from the church to take medications as a repetition of the trauma. Unwittingly, the church, in its effort to take responsibility for the improper actions of one of its agents, was repeating the problem and becoming the abuser by forcing him to take drugs and submit to their desire. I suggested he be frank with them about this repetition, and also suggested he give them a copy of Nemeroff's paper (Nemeroff et al., 2003) suggesting that chronically depressed individuals with trauma histories responded better to psychotherapy than to medications.

Bob's story i