I’m an agnostic on the question of psychiatric medication, by which I mean that I am not automatically for them or against. Actually I am a pragmatist– I am for them when they work for a client. And when they do not work, it makes sense either to move on to an alternative or be open to the possibility that medications may not be helpful.
My comments on this topic have been inspired by a recent article in the 6/30/12 Wall Street Journal by Katherine Sharpe entitled “The Medication Generation.”
The article’s subtitle, “Many young people today have now spent most of their lives on antidepressants. Have the drugs made them ’emotionally illiterate’?” certainly caught my eye.
During my college years, an early influence leading me to study psychotherapy was “The Politics of Experience,” by the late Scottish psychiatrist R.D. Laing. Laing was celebrated or excoriated for seeing psychosis as an understandable reaction to a world gone insane. As such he advocated not using drugs with many people undergoing psychotic breaks, particularly those who were young and without much psychiatric history.
His idea was that many people throughout history have reconstituted naturally after mental turmoil. If sensitive helpers support a person through their journey into madness, which could possibly also be a spiritual crisis, then the person can emerge more whole and integrated.
Critics dismissed Laing’s approach as at best romanticizing mental illness or as an ineffective homeopathic treatment and at worst as deluded and harmful. As a young therapist in the 1970’s I apprenticed on an in-patient psych ward where Laing’s theories were put into practice in a public hospital setting. There were times where the Ward Chief, Stan Meyerson, successfully battled MediCal auditors and had patients stay for weeks or even over a month unmedicated! Such a scenario would not be available today.
The point here is that in my earliest days I was thoroughly in the non-med camp. Of course, as I gained more experience I remember schizophrenic out-patients who did relatively well on Thorazine quickly decompensating when they went off. (BTW some of the intense anti-med opinions popular at the time were formed by mental health workers at Agnew’s Hospital who tried Thorazine themselves and became thoroughly sedated. Perhaps it should have been of more curiosity to those therapists why many of their patients were not even phased slightly by the same low dosages which rendered them practically immobile. Stan Meyerson, a proponent of treatment without medication, acknowledged that craziness, like all states of consciousness, had a chemistry. perhaps even a chemical signature, embedded in its make up.
The WSJ article suggested a significant number of today’s adolescents and young adults are now the first humans to be able to say that they have lived half their lives or more on medications. While being entirely open to the idea that medications, by which the author is discussing primarily SSRI antidepressants such as Prozac, Zoloft, and their ilk, can be helpful, Sharpe wonders if the Psychiatric community has not gone off the reservation by determining all patient problems are reducible to chemical imbalances.
It’s not academic for Sharpe, she sights her experience as a college student with panic attacks getting only medications from a psychiatric resident with no thought of psychotherapy. She questions the supposed value of exchanging the stigma of depression as being the expression of weak character for the relative blameless alternative of having bad brain chemistry.
She reminds us of the truism that it isn’t what happens to people so much as what people make of what happens to them that largely determines the state of their self-esteem. She states, “The idea that my deepest emotions were actually random emanations from my malfunctioning brain didn’t uplift me; it just further demoralized me.”
Sharpe also raises the point about the effect of antidepressants on adolescent identity formation. She suggests that antidepressants rob young people of dealing with intense emotions from which they may adapt. She doesn’t put it this way, but her viewpoint on medication is consistent with the current popular critique of suburban youth soccer leagues where all players receive participation trophies, even on the last place teams. Not benefitting from learning how to deal with difficult emotions may create the “emotional illiteracy” to which she refers.
She cites the case of Emily who began Prozac when she was 14 and wonders what she would be like if she never took anti-depressants. A related point is what happens to teenager’s identity on SSRI’s with respect to the well-known side effect of decreased libido. How does THAT become integrated into a young person’s psyche?
Sharpe’s observation stands in contrast to psychiatrist Peter Kramer’s landmark book, “Listening to Prozac.” Kramer, working with an adult population and prescribing the newly issued Prozac, noted that some patients felt more like themselves than they had ever felt before even though they had never had the experience of themselves that Prozac helped create.
So here we have Sharpe’s adolescents who wonder if they are something other than what their experience of themselves is and Kramer’s adult patients who are sure that what they have never experienced is who they are.
Sharpe wisely recommends young clients be frequently checked for whether psychiatric medication is still warranted. She found young adults who had been on a long term medication course and went on a drug holiday. In some instances, they returned quickly to their meds and sometimes didn’t return.
My belief is that the decision to take medications or not is a very personal decision between a doctor and patient. Of course non-medical psychotherapists such as myself have a duty to our clients both to recommend when psychiatric assessments are in order and in accordance with the scope of our licenses to recommend a trial of psychotherapy without medications when we have reason to support that decision. Serious depression with or without expressions of suicidal ideation should always be referred to a psychiatrist for medication evaluation.
These days I am fascinated by the power of the placebo effect in medicine and psychotherapy. Findings have shown that the belief of the practitioner is often a very powerful determinant in the success of the treatment.
This serves me well because I have always believed in the possibility of therapy making an important difference in the lives of my clients.
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