The use of medications in the management of mental illness is a suprisingly controversial topic. Many people seem to have opinions on the matter and they’re not shy about sharing them, whether they actually have any experience in the subject or knowledge about the issue. Of course, if we barred people from commenting when they don’t know what they’re talking about, the world would be a much quieter place, now wouldn’t it.
In one camp, we have the ‘big pharma’ position. The people who claim that using medication to treat mental illness is bad and wrong because people are being sold a line of goods by companies interested in billions of dollars in profits. It’s absolutely true that pharmaceutical companies do have a high level of interest in profits and are willing to run roughshod over consumers to earn money. But it doesn’t necessarily follow that using medications is inherently bad. Nor does it follow that mental illness is ‘made up,’ another common claim. Or people say it’s ‘overdiagnosed,’ that most people don’t ‘really’ have mental health conditions and certainly don’t need medications to treat them.
Furthermore, these people like to claim, even in those cases where someone really does have a legitimate diagnosis, taking medication is still wrong because it’s weak. You should be strong and overcome your condition, not just ‘take the easy way out’ with drugs. Apparently these people are unfamiliar with the lengthy titration processes needed with many psychiatric medications, with the serious side effects for the central nervous system, liver, and kidneys, some of which require regular testing while on medication to find out if the drug that is helping you is also hurting you. Regular liver panels are not ‘the easy way out’ by any stretch of the imagination.
These people are usually thinking of television depression when they hear the words ‘mental illness.’ They think of a person lounging around the house being kind of sad, but fundamentally able to function. They don’t think about severe depression and how it can limit functionality, may leave people stuck in bed for days, assuming they can drag themselves to bed. They also don’t think about other mental health conditions, which might cause panic attacks. Hallucinations. Giddiness. The dreaded psychosis. And how these things might impair functioning to an extreme degree.
The opposing camp argues that medications are terrific and everyone should be taking them to ‘control’ their mental illnesses, which are dangerous and scary and possibly bad if they are not ‘managed. People with mental health diagnoses have a social obligation to be ‘responsible,’ runs the argument, and thus definitely need to take medications. Other measures, like psychotherapy, aren’t effective, are possibly even bogus, you see. Pure quackery. How can you even tell if they work? Drugs are effective for everyone, they all work in the same way, they make treatment of mental health conditions straightforward and eliminate any social, cultural, or family responsibilities. After all, environmental factors don’t play a role in mental illness.
This demonstrates an equal lack of knowledge about medications and how they work. These people are demanding that patients risk side effects like permanent tremors, liver damage, seizures, and death to take medications in order to ‘satisfy the social contract.’ They’re demanding that people undergo complex titration up and down as they search for medications that work for them, experience symptoms like increased suicidal ideation and horrific rashes and other lovely things that psychiatric medications can create for patients. These side effects are considered an entirely acceptable and reasonable risk to ask people to take for ‘control,’ because mental illness is a scary thing that needs to be managed.
Absent from many of these discussions are actual people with mental illness. Some of us use medications. Some of us do not. We have very differing approaches to our conditions; some of us, for example, are extremely opposed to psychiatric medication and believe it’s overused. Others think it can be a valuable tool. Some of us know what it’s like to live unmedicated with our specific iterations of mental illness, and aren’t interested in doing it again.
Some of us are forced to take medications by court order. People with mental health conditions suspected of committing crimes may end up institutionalised for extended periods of time while the ‘justice system’ waits to see if they are fit for trial. This can include compulsory medication in an attempt to force patients to ‘get better,’ and the alternative may be permanent incarceration in a legal limbo. Untried, but ‘unsafe’ and thus unable to be freed. People convicted of crimes may be compelled to take medication as a condition of their probation, and can be returned to custody if they do not. This is a world where missing a doctor’s appointment can result in a warrant.
The damned if you do, damned if you don’t approach to psychiatric medications contributes to further stigma around mental illness. Either people are claiming it’s something made up, ‘all in your head[1. Oh the irony.],’ or it’s something inherently dangerous that must be managed and can only be controlled in one way.
We’ve come a long way in terms of treatment options for mental health conditions since the middle of the 20th century. We have a lot more medications, yes, but there are also many approaches to therapy and other treatments. One reason for that wide variance is the high incidence of mental illness, but also the high degree of individuality. People do not experience mental health conditions in the same way, which means treatments are unlikely to be one size fits all for patients, and that includes medications as much as psychotherapy. Both camps, with their dismissive attitudes, do absolutely nothing helpful for people with mental illness.