Author and journalist Maia Szalavitz has a guest column up at the London Times. Part confession, part social criticism, the piece is a moving look at the stigma attached to antidepressant use. Our culture--and I know, there is no "our culture," no "American culture" or "western culture"; there are too many subcultures, and this generalization will not uniformly hold true throughout all of them--doesn't like antidepressant use. It's easy for people who aren't depressed to demand of others (voiced or silently), "Why are you depressed? Get over it!" But depression is real, it's not something you just "get over," and sometimes talk therapy isn't the answer. Szalavitz wonders why the use of antidepressant medication in particular is seen as some sort of moral failing:
IF A PILL WAS developed that could restore the body after spinal injury without painful physical therapy, everyone would rejoice; well, everyone except unemployed physiotherapists. But the reaction is so very different to pills that restore the depressed mind without a need for emotionally-harrowing therapy.
Antidepressants are routinely dismissed as “Band-Aids” that merely hide the real problem, or they get smeared as being nothing more than nice little earners for “Big Pharma”. On the other hand, the talk therapists who oppose medication are portrayed as standing up for their patients, rather than as professionals protecting their own jobs and interests.
But why should those who already suffer from an illness have to suffer more to recover? Why, if medication works, shouldn’t they take a chemical shortcut to a healthier mind? Since mental health is not a struggle for most people, why do we demand extra work from those for whom it is? As a former addict who now takes antidepressants, I have long pondered this. My own story illustrates that suffering for its own sake can be counterproductive, while medication can ease pain without blocking emotional progress.
When I first snorted heroin I felt like one of the patients that the psychiatrist Peter Kramer quotes in his classic book Listening to Prozac, “better than well”. I was safe, warm, perfectly nurtured — for once, comfortable in my own skin....
Unsurprisingly, I soon added heroin to my coke habit and began a three-year descent that left me weighing 80lb and taking both drugs up to 40 times a day. I realised that I had to stop when I found myself begging a man I despised for heroin; I knew that the next step would be exchanging sex for drugs — that, somehow, jarred me into recognising the severity of my addiction.
[...]
[Cognitive therapy, effective at kicking the drug habits,] did not eliminate my bouts of depression, during which my self-hatred would return as furious as ever....
I began taking antidepressants about seven years after I kicked cocaine and heroin. Before that, both the self-help groups I attended and my individual therapist had discouraged medication. But I decided to try antidepressants when I declined into a state in which my ability to function at work was seriously threatened because I could not experience anything other than constant dread. Certainly, I thought, it was more likely to help than heroin, which was beginning to seem like a good alternative again.
Ten days after starting Zoloft I felt the first therapeutic effects. Soon, I again felt transformed, as I had in that seedy hotel, so many years before. Unlike heroin, Zoloft did not make me euphoric, but it provided a similar sense of comfort and safety. I felt like “myself again”, as another of Kramer’s patients reported. With antidepressants, I wasn’t “better than well”; I was the way I am when I’m OK.
[...]
Other opponents of antidepressants point to their side-effects, which can be a real problem, but the critics skate over that their preferred option of talk therapy can harm, too. Many widely used talk therapies for depression have been shown to backfire; while “recovered memory” therapy has split countless families by conjuring up false memories of abuse and “rebirthing” has killed people.
[...]
There is no moral superiority to talk therapy: sometimes “happy pills” really are the best fix.
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.
Posted by: Anna | February 21, 2006 at 08:29 PM
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.
Posted by: Joe | February 23, 2006 at 02:24 AM