Friday, 30 September 2011

Dr Conrad Murray

The trial of Dr Conrad Murray accused of manslaughter of Michael Jackson will test the ability of jurors.
Michael Jackson did not want psychological treatment but addictive drugs. I know that for certain.
Dr Murray got a job, working as private physician to Michael Jackson and most doctors would never accept such a job. I think that is why he was paid so much. Maintaining drug addict is a stressful job and very risky. One cannot control an impulsive and dis-inhibited person and the risk of overdose and being blamed for it so high that most doctors do not want anything to do with addicts.
Reducing dosage of addictive medication is really difficult if the social and psychological environment has not changed. The drive to take drugs just does not go away if causation is not removed.
Dr Murray had an impossible job. Even if Dr Murray had all the psychiatric skills to help Michael Jackson he would be rejected by his patient who just did not have the courage to face the emotional pain of his past traumas.
Tragedy was predictable for Michael Jackson years ago because of his attitude to the needed treatment..
Even manufacturers of the medication have been having problems and production was reduced.
Insomnia is what Michael Jackson complained about and asked Dr Murray to help him with. The key thing about insomnia in patients who suffered abuse in childhood is that they do not want to sleep as they are hypervigilant. They are alert in order to prevent abuse. For the patient the issue is one of control and for therapist to teach patient how to put issues of control in perspective. None of us have full control of our lives ever. Even the most powerful person in the world does not have full control of everyone and everything around them..
Many people are helped enormously by realization that in fact they do not want to sleep. Understanding oneself (fear of falling asleep) and the true needs (rest v. control) would have been the first step.
Addiction to hypnotics is more common in those who suffered abuse and I wrote the first paper on it in psychiatric day population. At that time it was believed that drug addicts were disordered personalities but I discovered it was more likely to occur in those who suffered abuse irrespective of psychiatric diagnosis.
Higher and higher doses of hypnotics are used by patients as they fight sleep and become tolerant to benzodiazepines (lorazepam is one example).
Those who accept psychological/social/psychiatric interventions do recover from addictions and many of their symptoms of post-traumatic stress disorder improve even after many years of chronicity.
It is irrelevant what Dr Conrad did or did not do, as it was just a matter of time before Michael Jackson killed himself as he did.


Anonymous said...

Thanks for enlightening about 'addiction'.So the people who suffered abuse have sleep problems and addiction problems. And they complain about not getting sleep when infact they are fighting the sleep ?

Doctors4Justice said...

You are welcome.
Yes, traumatic events lead to avoidance of sleep as person is on guard to avoid recurrence of trauma.
In sleep we lose control and traumatized people fear loss of control.
So many people can be helped just through understanding of their own symptoms.
It is so much easier to deal with addiction to hypnotics if person understands why they are in the situation of wanting medication just to sleep while at the same time fighting sleep. I found patients are amazed when given this insight and usually say: "You are absolutely right!" It is such a relief just to have this insight for most people. Therapy can then shifts to the issues of control and power.