In a new editorial Lancet Psychiatry proposed to change the names of psychotropic medication. The arguments for the change are not trivial, to be honest. Here is the first paragraph:
What’s in a name? When it comes to psychotropic drugs, a lot. For doctors, a second-generation antipsychotic might sound like a newer, better, more advanced option. For patients who have finally summoned the courage to seek help for an anxiety disorder, being prescribed an antidepressant might suggest that the doctor wasn’t listening to them and dishes out happy pills to everyone. People prescribed an antipsychotic for depression might legitimately be concerned that their psychiatrist, without telling them, believes they have a psychotic disorder.
At least at face value they are reasons which should at least be considered. Moreover, I would imagine that things look different from the perspective of a clinician who has to deal with those issues daily. Accepting that, I would like to offer my perspective, as it’s different. Also, importantly, this is one of those occasions where psychiatry does talk about language, so I might have something to say, even though Lancet does not mention a view from someone professionally dealing with language. The argument for the change comes from “leading psychopharmacologists”. Just imagine a linguist trying to tell them something about psychopharmacology…
So, let’s consider the argument presented by Lancet. First, the change of the name will help the doctors. I must admit that it worried me. Do doctors really not understand the difference between groups of drugs and they must be helped with changing names. Smiley-face pills, sad-face pills? I am not really convinced here, sorry.
So what about patients who are confused about antipsychotics. After all they are used not only in the treatment of psychoses, but also depression, bipolar disorder, anxiety and the poor patient’s head is spinning… Except, I somehow doubt people will campaign for the change of the name of aspirin which has a number of uses. How do we, patients, manage understanding it? What about antibiotics? Sore throat – antibiotic, earache – antibiotic, you name it, you will be given the stuff. Beta-blockers and steroids are also used for different conditions and we somehow manage. How do we survive?!
Now, the paragraph I quoted, starts with a very famous line. Let me remind you the rest of the much quoted snippet from Romeo and Juliet:
“What’s in a name? That which we call a rose
By any other name would smell as sweet.”
That’s the rub. To be completely honest, I suspect that the issue really is in trying to get the psychotropic drugs to smell sweeter. We re-label things and Bob’s your uncle – we have new drugs! They are not liked, called ‘chemical straitjacket’, but let’s not deal with perceptions, let’s not change the drugs, let’s just re-label them! And, frankly, the belief in the power of re-labeling continues to amaze me. That said, I have no reason to doubt that the intentions behind the editorial are honest and rooted in genuine concern. My cynicism is not directed at the author of the editorial, rather at the dominant psychiatric discourses.
And so, it’s perhaps worth saying that no, you don’t change my suffering by calling it something else, although you might irritate me doing it. It’s worth reminding ourselves that the drugs will ‘smell as sweet’. Just like a kidney will remain a kidney.
However, the of name of drugs is not insignificant here. Joanna Moncrieff, in her book The Myth of Chemical Cure, offers a fascinating story of how neuroleptics became antipsychotics. And so let’s assume for a moment that, indeed, re-labelling of psychotropic medication is needed. Maybe it is an issue for a group of patients who struggle with antipsychotics perceiving them as upping the ante. And here we come to the core of the problem. Considering it, I would suggest that perhaps, just perhaps, it’s worth taking on board linguistics as a discipline that deals, you know, with language.
There is one crucial question that should be asked in the name changing exercise. One which has not been mentioned by Lancet, nor anyone else. The question is:
What do you want to achieve by changing the names?
Is it really just clarity and if so, clarity for whom? Or is winding back time and change of ‘antipsychotics’ to ‘neuroleptics’ is on the cards? Or do you really want to achieve the change from, I don’t know, haloperidol to Heavenly nectar? Or from fluoxetine to Gates to happiness. Yes, I am exaggerating, but the point is valid, I think. Before there is any sensible explanation as to what exactly the changes are to achieve and how they are supposed to do it, I cannot really get excited by the labelling clarity of something which is also called a chemical straitjacket. Or, if you prefer antidepressants, The pill that steals lives. Just to be clear, the link is to the blog of a professor of psychiatry, David Healy.
Having dealt with what is really both a political and linguistic question, I would like to raise two other issues. My first point with Lancet’s argument is that it forgets doctors could actually take the time and explain all these issues to the patient. You know, just like I occasionally get antibiotics for a viral infection, because my GP says….He talks to me, explains.
Of course, I do realise that Lancet is not at all advocating absence of conversation, yet, I fear, this is a potential unintended side effect. So, consider not changing the names, but just explaining what exactly you do and why you prescribe me these pills, even though at face value it makes little sense. I promise to listen!
The second thing comes again from David Healy and the infamous Study 329 (in a nutshell linking some SSRIs to suicidal behaviour). Instead of re-labelling drugs, I would prefer psychiatry deals head-on with safety, efficiency, or what Healy calls another drug crisis – failure to discover new medication.
Re-labelling, as much as I, a linguist, would like it to be a key thing, kind of pales into insignificance.