Compliance And Bipolar Disorder
Trusting Your Diagnosis of Bipolar, today’s post on Bipolar By Chance, a blog authored by Donald Kern, who addresses bipolar disorder from the point of view of both a patient and a psychotherapist, focuses on treatment compliance.
While the “To comply or not to comply” riff on Hamlet’s soliloquy is clever enough that I co-opted it for the title of this entry, the key point of the post, by my lights, is the following:
In my own [Mr. Kern's] case it took 12 years before I firmly accepted that the adherence to taking medication on a daily basis and for the rest of my life was a necessity; no more questioning, but rather acceptance.
I’m struck by the similarity between this declaration and the conclusions reached by other patients who write about their disorder.
It does seem likely to me that, at least for some patients, surrendering their ambivalence about the recommended therapy is an essential step in the implementation of an optimal treatment plan.
Not only is that an interesting theoretical possibility, but it also highlights an instance of cultural politics interfering with patient compliance management.
First, for the purposes of this thought experiment, we stipulate that a subgroup of patients is likely to successfully implement an effective treatment if and only if they buy into the diagnosis and suggested treatment wholeheartedly, to the point of dismissing any negative thoughts about therapy. Again, this is an altogether reasonable, albeit unproven, idea.
The problem lies in the next step. In today’s social context, any clinician – but especially any physician – who advocates, regardless of how modestly and how apologetically, that the patient believe in the treatment plan without reservation, can expect accusations of paternalism and condescension at best and, all too frequently, charges of unethical subjugation of the patient.
The only other point I want to make about this post is that I am less certain than Mr. Kern seems to be that buying into ones diagnosis is sufficient to result in adherence in most patients.
That, however, is a small point and does not deter me from suggesting that viewers will garner insight and information from reading Mr. Kern’s entire post, which is available at Trusting Your Diagnosis of Bipolar.