(The Assault on the Body and Mind) The Prescription Cycle

So after the previous episode, we're now going to start to unpack this bit by bit over the next two weeks and we'll start today. Week one this week is the system. So you go to a doctor with a problem and you leave with a prescription. So this is so normalised that most people don't recognise it as a structural event.

They see it as medicine, as care, as the system working. But if you watch the mechanics, if you trace what actually happens over months and years, what you don't see is care. What you see is a cycle and the cycle has a direction and the direction is always toward more intervention nevertheless. So you present with a symptom.

Let's say it's anxiety. The doctor listens, the doctor assesses and then the doctor prescribes an SSRI, which is basically a selective serotonin inhibitor. And what the drug does is modifies your neurochemistry. So the anxiety decreases, the system has worked and you're grateful.

Except the drug has side effects. It disrupts your sleep, it dulls your libido, it creates a feeling of flatness and the flatness isn't necessarily depression, but it's an absence of the highs alongside the absence of the lows. So you go back to the doctor and you say, these are the things that I'm feeling. And now the doctor prescribes you a sleep aid.

Let's say mild sleeping tablets. So now you're on two medications. So the sleeping tablet then makes you groggy in the morning. Your energy drops, your focus declines.

Your productivity at work suffers. You mention this to the doctor again on the third visit. Now you'll prescribe something for focus. Now you're on three medications.

The focus medication increases your heart rate, your blood pressure rises. This is then flagged at your next checkup. And now you're prescribed blood pressure medication. Now you're on four medications.

And each one was what they would call a reasonable medical response to a presenting symptom. Each one was prescribed by a competent professional acting within the standard of care. No one prescription made an error in isolation. The system functioned exactly as designed.

And this is the fundamental problem. The system is designed to respond to symptoms with pharmaceutical intervention. It's not designed to ask you why the symptoms exist. It's not designed to examine the root cause.

It's not designed to consider whether the anxiety that started the entire cascade was caused by something that could be addressed without medication. Perhaps a nutritional deficiency, a relationship that you are sacrificing incoherently within. A job that you are sacrificing incoherently for that was slowly destroying you. A gut microbiome disrupted by years of eating processed food.

The unresolved grief that was never given a space to be processed. These possibilities are never explored in the doctor's office. And that's not always because of incompetence. It's because the model doesn't always accommodate them.

The model has a five or ten minute appointment window. The model has a pharmaceutical formulary. The model has clinical guidelines that map symptoms to prescriptions. The model doesn't have time for a 45 minute conversation about what you eat, how you sleep, what your relationships look like.

Whether your work aligns with your values or whether the life you're living is one that your nervous system can sustain. And so, inevitably the cycle continues. Each drug manages the consequences of the previous drug. Each appointment adding rather than subtracting, the patient doesn't become healthier, just more medicated.

Not more sovereign over their own body, but more dependent on the system that manages it. The average person over 65 in the developed world takes between four and seven prescription medications daily. That is four to seven different prescription medications daily. And each one is prescribed for a specific reason.

And each one is interacting with the others in ways that are not frequently fully understood. Because the clinical trials that approved each drug tested it in isolation, not in combination with four others the patient might already be taking. This is called polypharmacy. And it's not an aberration of the system.

It's the logical end point of the system. A system that responds to symptoms with drugs will inevitably produce patients who are on multiple drugs. This is structural. Because the drugs produce the symptoms and symptoms in this model produce more prescriptions.

No one in the system is tracking the cumulative effect over time. The cardiologist prescribes for the heart, the psychiatrist prescribes for the mood, the endocrinologist prescribes for the thyroid, the gastroenterologist prescribes for the gut. Each specialist operates within their own domain. Each prescription is reasonable within that domain, but no one is looking at the whole.

No one's asking what's the combined effect of seven pharmaceutical agents operating simultaneously inside a single biological system. Because the system is not designed to ask that question. The system is designed to add, never subtract, never to simplify, never to ask whether the fifth subscription might be treating a symptom caused by the second one, which was treating a symptom caused by the first. Never to ask whether the fifth prescription might be treating a symptom caused by the second one which was treating a symptom caused by the first.

At no point does the cycle reverse itself. At no point does the system say, perhaps we should reduce, perhaps we should examine the foundation. Perhaps the anxiety that started this cascade 10 years ago was a signal. The body telling you something was wrong.

And instead of listening to the signal, you silenced it with a chemical. And the body unable to communicate through anxiety found another channel. And we silenced that too. Until the body is managing a chemical environment, so complex that it's original intelligence, the intelligence that evolved over millions of years to heal, regulate and protect itself, simply cannot function.

The prescription cycle is not a failure of medicine. It's medicine working exactly as its business model requires it to do so. Each prescription is a new subscription. Each side effect is a new revenue opportunity.

And the patient at the center of the cycle has been converted from a person seeking health into a consumer sustaining an industry. If this transmission shifted something in you, there's a short book that shows you why. It's called Before Approaching the Threshold. There's a link in the show notes to access it, and it's free.

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