Frequently when a therapist suggests that his or her patient might be helped by psychotropic medication the suggestion is met with concern, doubt, or even anger. This is even the case when a patient has been suffering for years from mood, impulse, or attention-related issues. Additionally, often patients try medication, experience relief, and then decide abruptly to stop taking medication without consultation with their therapist and psychiatrist; often while simultaneously self-medicating with illegal drugs, alcohol, or unhealthy behaviors. This can be especially true during the holidays, when the pressure to be happy is intense, the feelings of depression are frequent, and the availability of unhealthy behaviors is high.
No doubt prescribed psychiatric medication is not a perfect science: there are side-effects and sadly medication doesn’t always work and provide the relief of symptoms and quality of life improvement sought by the patient. However, all too often side effects and/or the efficacy of the medication are not the reasons people stop taking helpful medication. Instead, the reason expressed is more likely to be “I just don’t want to be on medication (for the rest of my life).” Why?
Unfortunately, in large part this is because there remains serious stigma, shame and fear of psychiatric medication and psychological treatment. According to NARSAD, the Mental Health Research Association, one in five Americans suffer from mental illness in a given year but only one-third seek treatment. In San Francisco it is estimated that close to ten percent of the population suffers from a serious mental illness. In a recent study, psychiatry residents – those doctors learning to help people with mental illness – acknowledged that while they would tell others about being in psychotherapy, they had not admitted to anyone that they were taking psychotropic medication because of the perceived stigma even amongst their peers and superiors. In a study earlier this year, it was found that even the drug companies that market psychotropic medications to doctors were perpetuating rather than breaking-down the stigma attached to mental health problems.
Of course, the ads from the medication companies and fears of the psychiatry residents are simply a reflection of the societal stigma that still exists. And yet medications have given so many people a chance at living a happier, more fulfilled life. Rather than a weakness, character flaw, or sign of a mental deficiency, a psychiatric condition is a medical condition that needs to be treated. Without a doubt, there are many ways to approach psychological problems without medication. This can range from psychotherapy, to meditation and/or yoga, to exercise, to lifestyle interventions, or some combination these interventions. But in some cases, just as with any medical issue, medication can make a tremendous difference. For example, medication can make a profound change in a patient who has been in psychotherapy for years and has made tremendous progress psychologically, emotionally, and in making healthy lifestyle choices, but remains unable to shake a pervasive negativity about herself that makes it very difficult for her to achieve satisfying, intimate relationships. Once on a low dose of anti-depressants, she may find that the negativity has lifted and she is much more healthy psychologically and capable of relationships than she imagined.
Part of the resistance to medication is due to a societal backlash. Pharmaceutical companies make a profit from selling medication and our culture has a tendency to look for the easy answer to problems, sometimes in a pill. Many have turned to medication inappropriately – over-medicating our children or those struggling with mental illness. It has become clear through these experiences and in research that medication is not always the answer and most often not enough as a solution. However, it is also clear that in some cases medication is one tool in the toolbox of interventions that can make a tremendous difference.
Samantha Smithstein, Psy.D. and Elizabeth Corsale, MA, MFT