Article 7 :Words can, what medicines can’t.

-Dr Raviteja Innamuri MD, DPM, DNB, PGDMLE

Consultant Psychiatrist, Nizamabad We cannot deny the power of words. We witness it on a day to day basis. It is astonishing how just a limited 32 characters give shape to incessant forms. Words are simple, yet complex. They make us, and break us. We make our persona, our decisions and ultimately our fate based on the interpretation of the words that we hear. We decide, hide, and declare our lives through words. This is the impact of ‘just words’.

Healthcare as a profession is revered and prestigious. In my opinion, it’s held in highest regard not because of monetary gains but because of the impact it can have on our fellow human beings. Reverence, praise, nobility and wealth are simply a reflection of this impact. Such impact is made by the medication/intervention and the words we dispense at the end of our consultation. For example, just the manner in which a diagnosis is revealed to the patient can bring either hope or throw the patient into an abyss of hopelessness and helplessness. The impact of words is of great significance especially in psychiatry where words are diagnostic, therapeutic and prognostic tools! Remember, words, can, what medicines can’t.

Psychiatry relies heavily on the most powerful weapon that humans have evolved over centuries – language. Language – which perhaps evolved for the purpose of social bonding and communication is the biggest tool for growth. Language not only brings growth on the outside but also on the inside. The right kind of language that one adopts for self-talk not only allows him or her to blossom on the inside but spreads happiness to people around them. Therefore, it also becomes a tool to tame the most powerful organ on this planet – the human mind.

As students of science who practise evidence based medicine, here a few interesting observations to ponder upon. Let’s take clinical depression as an example – if we note the response to antidepressants in comparison to placebo, several clinical trials report only about 20-30 % higher response. Imagine! Just about 20% higher response than the sugar pill! Literature also informs us about instances of placebo-induced psychosis! The power of placebo in other way out is simply the power of the human mind (which naively believes the placebo to be the true medicine)! Therefore there is increasing evidence that a good doctor- patient relationship can enhance the effectiveness of treatment. In Psychiatry, this is very clear across all treatment guidelines – psychotherapy in combination with pharmacotherapy is superior to dispensing a few pills alone.

Historians who study medicine say that we are completing a full circle. From believing in only priests, nature, and, relying on clairvoyance of oracles, to drifting to pharmacology and now incorporating non-pharmacological treatment is perhaps a healthy circle. Interestingly, we are moving further in this direction. We now have literature to suggest that the changes that occur in the brain as a consequence of medication or psychotherapy are the same. Now, we even have medication that can enhance the effect of psychotherapy by increasing the neuroplasticity of the brain (that is to be taken before the psychotherapy session).

A few months ago, I was seeing a young mother struggling with depression. During therapy it was clear that her special child was the major stressor for her depressive episode. In all honesty, her entire life is consumed in taking care of the child. She knows that this is a huge burden taking a toll on her but feels ashamed to admit it as a mother. As a pious woman from a conservative brahmin family, she was struggling with the religious explanations of her child’s fate. During one of the conversations, I realised that she was desperately trying to understand the (medically unanswered) reason for her son’s fate. When she told me that she believes in multiple births, I recalled a particular section of the Veda which explains that an intellectual in one life is gifted to a virtuous couple with disability to be taken care of in another life. The mother looked at me in silence, and tears of happiness rolled down her cheeks. She asked me again, “really?” and said, “thank you.” For the next session she came along with her son. She was happy and for the first time has been able to accept his disability.

Incidents such as these reaffirm to us the power of words. I can vouch that no antidepressants will be able to produce the same effect. Because, words can, what medicines can’t.

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