As a clinician in the field of mental health, I have developed an opinion or two on the topic of psychotrophic medications. I began my career as a skeptic: reluctant to diagnose, and wary of medications.
I’d seen debilitating side-effects – some of which were permanent, like tardive dyskinesia – as well as ‘paradoxical responses’, when the medication ends up making the individual’s condition worse. Most of all, I’d seen patients destabilized by the process of starting, stopping and switching medications – a total nightmare to undergo.
Mainly, I didn’t feel comfortable labeling anyone in a potentially stigmatizing way, nor did I feel comfortable insinuating that anyone required medication in order to be normal. I saw too many youth offhandedly doled off prescriptions – and we’re talking some heavy-duty stuff, not just your typical SSRI or SSNRI. Worst of all, their symptoms and behaviors were largely caused and exacerbated by environmental factors. Medicating seemed unnecessarily pathologizing.
My opinion changed after working with the severely and persistently mentall ill population on an Assertive Community Treatment (ACT) Team. These clients are a small minority who’ve had numerous inpatient hospitalizations. You know the homeless man talking to himself on the street? This is the level of mental illness I’m talking about. Nearly all of my clients were actively psychotic and all had experienced debilitating instability caused by mental illness. Even stable, the quality of life they had was negligible.
Finally, I could admit that yes, in certain cases – medication was required and should be prescribed. For these patients, it was the difference homelessness and almost total isolation; of being able to carry a conversation or not. For some, it was the difference between living in total fear and paranoia versus having moments inner peace. At their baseline, these patients needed and deserved relief. Without medication, these individuals would be hospitalized, incarcerated, or homeless.
But what about the rest of us? Where do you draw the line between medical necessity, and the gratuitous over-prescription of medication?
I now fall somewhere in the middle. Debilitating or not, there are times when we could all use a respite from the discomfort of anxiety, the occasional panic attack, or bouts of extreme emotional duress. I simplify it and put the choice in the hands of the individual: Are your symptoms costing you a certain quality of life, and is that worth it to you?
However, the most influential factor in the evolution of my stance on medication was finally processing my own experience as a child of seeing my mother battle depression.
My mother was always difficult – a disciplinarian, with an intensity and rigidity of thought that even seemed off to me, even as a child. She had frequent mood swings, and often yelled at my father and myself – and I was a feisty child, so we butted heads often. I was far too young to make sense her behavior in terms of ‘symptoms’ or ‘pathology’; to me, she was always just my mom.
After my parents’ divorce, my mother deteriorated into a state of severe depression. By then, I was a self-involved teenager and only noticed things experientially; as she gradually became more withdrawn, our conflict stopped. I do remember waking up one morning to discover that she had been removing wallpaper in the kitchen all night. Forget the bizarre choice of activity, but to do so all night? It was confusing and disturbing.
She went through a phase where she lost all motivation to even dress herself in the morning. I was rarely home, but I knew she had spent entire days on the couch, still in her pajamas. The house fell into a state of disrepair at one point, and she had stopped cooking for us long before. It was a drastic shift from who she had once been, but when I asked her about it, she would become defensive and lash out angrily at me. So, I stopped asking and avoided her altogether.
I know that it was not my responsibility to get her help then, but I do regret that no one was there to point her in the direction of getting help for herself. This burden, weighing my conscience over the years, likely drove me to become a clinician in the first place, and to work in the field of mental health at all.
The experience remains a source of sadness and guilt for me, but these days, I try to focus on the positive. My mother recovered from her depression and has remained stable since – with the help of antidepressants. She has turned her life around, and we have a great relationship now. She is a far cry from the anhedonic state she was once in.
There is never any use in asking “What If…?,” but for the sake of this article: I do believe her symptoms impacted our quality of life, and mostly I believe she deserved relief from suffering. Medicating is never a decision to be taken lightly, but under the care of a qualified doctor, it can be life-saving. I will never fully know the impact of seeing my mother in such a vulnerable state, or the complicated feelings that the atypical role I found myself in brought up for me, but I do remember what it was like to feel that I was on my own during my developmental years. I personally think that used appropriately, medication could have helped her take care of herself, at the time. And her recovery has been due – in large part – to the introduction of, and adherence to, a psychopharmacological regiment. I guess that my stance could be summed up as being in favor of medications, but as always, in moderation.