If your child acts out in school continually, should you put him or her on medication or should you work with him or her using talk therapy to discover what is happening? Conscientious mom, Ava (a finely calibrated portrayal by Nicole O’Brien), takes her son Adam (Alexander Nifong evolved the character from middle school years to college age with authenticity and sensitivity), to a doctor who prescribes medication for him to calm him down. It is a loving and benign act by a mother who wants the best for her child. What happens is an ongoing nightmare that disrupts the entire family, steals their peace and sets them into a roiling volcano of anger, violence and confusion from which there is no respite for a decade.
A Bitter Pill by Gayle Damiano Waxenberg, directed by Daniel Neiden produced in a limited engagement by The Telling Company for the Venus/Adonis Theater Festival 2016 should be presented again in additional venues. The ensemble acting shepherded by director Daniel Neiden is spot on. The staging, musical accompaniment (Rachel Kaufman, also Music Director), pace, atmosphere, sets, and lighting which superbly showcase the universal themes and story development, are worthy of a wider audience.
Indeed, the import of the play is relevant to every young couple who has children or who is planning to have children, for at bottom, The Bitter Pill is a clarion call against the pharmaceutical industry’s allure that pills can “solve all problems” and mitigate the fear that “something is terribly wrong” with one’s son or daughter. For parents who trust doctors with their children’s emotional health and well being, the play relates a tragic issue of our culture to look for “quick fixes” from “experts” who appear to have the knowledge of what is best, when in effect they are too often blinded by profits and captured by sub rosa perks the pharmaceutical company offers them to use their expensive, patented drugs.
Waxenburg shows what oftentimes happens when parents too readily trust doctors and the pharmaceuticals they push to emotionally medicate their children for issues that can be dealt with through cognitive and group therapy. The play begins in the present with a brief narration and haunting, symbolic song sung by Chloe (a fine job by Alesandra Nahodil), Adam’s sister. It moves in flashback to the years her brother Adam was driven to near insanity by prescription drugs. He lost his youth and was lost to her and the family because of continual psychological misdiagnosis.
Like many middle class parents, Ava trusts her doctors (all played by Leo Giannopoulos with typical arrogance, and concern), each time they whip out the prescriptions to treat the side effects of the side effects of the side effects of the meds another doctor prescribed. Unbeknownst to Ava, the side effects morph each diagnosis of Adam’s emotional problems from anxiety, to depression and suicidal thoughts, to psychotic conduct disorder and hallucinations, to Bi-polar disorder-manic depression, to PTSD.
Adam is first treated with Paxil (personified by Brandon Duncan with frenetic abandon), to calm his anxiety as a youngster at age 11. Though he initially appears to be getting better, the drug’s side effects impact him, and when he tells Ava and the situation persists, eventually doctors decide to get him off Paxil and give him something else. Unknown to the doctors, the drug manufacturer didn’t provide sufficient warning that youngsters must be gradually weened off Paxil. When Adam goes “cold turkey” he has severe emotional pain and anger and turns violent. As Adam and Ava attempt to confront the problem, completely confounded, they are both driven to the edge. Looking for relief from the chaos of Adam’s emotional state and the increasing disorder of their family life, they continue their pursuit of health at the hands of medical professionals/experts who diagnosis Adam’s symptoms created by the side effects, without actually giving a thorough diagnosis or treatment plan beyond medication.
Thus continues the cycle, which revolves into an ever-increasing web of needless pain, torment, hospitalizations, Emergency Room visits, destroyed youth, and neglect of sibling Chloe, who is mostly raised by baby sitter Fran (Whitney Biancur). Among the drugs often prescribed for youngsters like Adam, listed in a large word puzzle, the ensemble circles such drugs as Tenex (for ADHD), Risperdal (for antipsychotic, bi-polar behavior), Depakote (for manic episodes), Lithium-the gold standard (for manic episodes), and others. When Adam ends up in the ER one time, doctors are shocked at the toxic level of medication in his body, legally prescribed, FDA approved.
However, a turning point comes when Adam shows his mother the long term side effects of Risperdal use: Gynecomastia. His weight gain from the medication isn’t just all over his body; he has grown breasts and needs cosmetic surgery to reduce them. He is fortunate. With Risperdal use, some boys lactate and their enlarged breasts (some reported to a D cup), leak milk.
After the liposuction of Adam’s breasts, mother and son finally end up seeing a doctor with an alternative treatment plan. The risk is great. He suggests Adam does not have bi-polar disorder. Should Ava and Adam believe him? Will he ever get well?
The Bitter Pill, whose ironic title is well noted by the audience, is rapidly paced and illustrative of the hyper panic mania and fear that has overtaken the family in their desperation to find a solution to Adam’s sickness. It is a tremendous irony that the medications produce the sicknesses they are supposed to alleviate: i.e. to alleviate depression one must risk the side effect of suicide.
The side effects to each of the medications prescribed to Adam are declaimed by Brandon Duncan who also personifies the medications and spins out their addictive urges in Adam’s ear, if he attempts to stop them. The diseases created by doctors and pharmaceutical companies, i.e. childhood bi-polar disorder, PTSD, are declaimed by Whitney Biancur. And with each drug Adam takes, the litigation settlements in the billions are given. The litigation is because of the negligence of the pharmaceutical company’s failure to notify doctors of the side effects or because of the faulty research results given to the FDA. Additionally, placards with news articles state salient facts about prescription drug over-medication by doctors as well as incorrect diagnosis of children.
The fount of information the play reveals in an entertaining way is enlightening, disturbing and downright horrific. It is also, tragically true if one checks the statistics of pharmaceutical negligence recorded in the billions of dollars. However, the billions settled in lawsuits are a “drop in the bucket,” representing about 15% of the total profits the companies rake in. And so it goes. Until human lives are viewed as more worthwhile than corporate profits, until governmental agencies are properly staffed so that they can monitor and prevent pharmaceutical company abuses, the same will abide. It is too lucrative for the companies to stop producing toxic, harmful medications the FDA will surely approve.
In the interim, The Bitter Pill cautions: cognitive therapy sessions may take longer but are non-addictive without dangerous side effects. And there are alternatives to hard line prescription medications. But don’t ask your doctor, especially if he is substantially aligned and beholden to Big Pharma.[amazon template=iframe image&asin=0807021997] [amazon template=iframe image&asin=0199350647] [amazon template=iframe image&asin=0910707677]