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« bla bla bla [sic] (Joe) | Main | Day of Remembrance »

February 19, 2006


True enough, though really there's too much stigma attached to anything that has to do with mental illness, therapy included.

Most studies show that the best treatment for serious, clinical depression is some combination of medication, cognitive behavior therapy (case conceptualization), and dynamic therapy ("talk therapy," which, depending on who you ask, either provides people with insight into, or provides them with a narrative for, why they are so unhappy).

In my professional backgroud as a lawyer representing low-income people with mental disabilities, I've certainly represented clients who (in keeping with Szalavitz's article) were willing to seek therapy but, because of the stigma attached to medication as an acknowledgment of inherent (medical) rather than environmental causes for their trouble functioning, were unwilling to take drugs that might have helped them.

I've also, however, had clients for whom medication does not work: almost 30% of people, for example, do not respond to any of the SSRIs that are generally used to treat depression. I got that number from a psychiatrist at a drug industry sponsored function. There's big money in them thar' hills of psychotropic medication, which represents the largest group among the Top 10 best selling drugs.
There's not much money, in contrast, in therapy. Partly because of the incentive of the pharmaceutical companies to make people comfortable taking their top selling drugs, I'm pretty hopeful that the stigma attached to taking psychotropic medication will continue to fade, especially with regard to depression (we have a much longer way to go with regard to, e.g., schizophrenia).

I worry more about articles and attitudes I come across (see, e.g., Steve Lopez's recent series in the Los Angeles Times) that sees mental illness as a simple problem that could easily be treated with medication, so that the presence of people with obvious mental illness in our communities reads as a need for forcible medication. "Normal" or "disordered," our mental state, and its impact on our ability to function, is a complicated combination of physical and environmental factors. I don't think we disagree at all, I just wanted to emphasize that happy pills are not just for failures, but those who choose not to take them or whose psychological problems aren't helped by them aren't failures either.

You're right, we definitely don't disagree--I had only shared the side of the story seen in Szalavitz's own experience. I'm glad you brought up those other issues.

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