It is a human reaction to resist the idea of any form of illness, especially one that is chronic and requires long term decisions about treatments and their possible side effects on the body. It is rare that when a person is first diagnosed with clinical depression that she will embrace this idea and all that treatment can entail. For someone who has struggled for some time with the various symptoms, however, there can be a sense of relief to finally have a name and a possible path forward with their trouble.
Sometimes a person who comes to see me has been told by another doctor or therapist that she suffers from depression but she has rejected their evaluations and refused further treatment. By the time she comes to see me she may have tried multiple methods of improving her mood and energy levels or dealing with other markers of the depression syndrome. Some of these methods are definitely helpful: exercise, a healthy diet, or weaning from the use of alcohol or other drugs used to mask or relieve her symptoms, for example.
When I suggest that she appears to be struggling with depression and speak of the possibility of medication as one path to a better quality of life, and in fact, a path that can facilitate and speed the work done in psychotherapy, I am often met with variously intense levels of refusal. Some have simply not returned to talk further with me; some have made it clear that this path will never be taken and that, if we are to continue to work together, I am forbidden from discussing the topic with them in the future; others tell me that they would prefer to “work their issues through” in psychotherapy rather than taking meds.
The latter statement reveals the commonly held idea that emotional/psychological difficulties are a function of some undefined part of ourselves distinct from our brains. Such a distinction can be made only in an intellectual fashion. In the lived reality all elements of our beings are interactive. A deeply successful psychotherapy experience, or an on-going meditative practice, can modify brain and nervous system functioning. By the same token a medication can allow a healthier functioning of the brain to provide greater focus and nervous system grounding. This in turn will facilitate the development of toleration for and understanding of feelings and experiences that formerly overloaded and overwhelmed the client, making the odds of her learning new approaches to and resolving her troubles quite problematical.
For some clients the suggestion that their troubles may have a physiological component can be quite threatening. The spectre and stigma of “mental illness” still hold sway for most people even though socially we are making strides in this regard. Problems with any other organ in the body can be diagnosed and treatments suggested without this intensity of reaction. It’s not a great thing to be told, for example, that I have developed diabetes or that my lungs have been compromised, but these problems fall with the realm of “normalcy” and are not the stuff of fear and shame. I can talk with my family and friends easily about what is happening. This is not true when it comes to the acknowledgment that one’s brain is not functioning properly. We are simply not logical when it comes this part of our being. We might have sympathy for and be supportive with a friend who is on a medication but shy away from its use ourselves.
It is my sense that much of the resistance that is advanced to taking psychotropic medications stems from fears – perhaps at root a primitive fear of being poisoned. Many rationales are given for a refusal: I don’t want to gain weight; I never take medication of any kind, not even an aspirin, so why would I take this stuff; It might make me into a different person whom I wouldn’t recognize; It might take the creative edge off my work; I know someone on medication and I can’t see that it’s helping her; I don’t want to feel drugged; It’s a panacea dreamed up by pharmaceutical companies to make profits; The world is being drugged and medicated and I’m against it. The list of reasons for refusal is endless.
Generally people will take other medications recommended by their doctors without difficulty. Not so when it comes to these. Absolutely, it takes courage to embark on a course of drugs that have, like all medications, a list of possible side effects, when we are conscious of the fact that the intention is to change the current functioning of our brains. It’s a hard decision to make, one that some people defer for a long time until convinced that other ways that they are using to climb out of their periods of depression are inadequate. Is it true that Big Pharma is making lots of money from these meds? For sure. Is it true that too many drugs are being prescribed to people? Very possibly. Having a prescription and compliantly taking the medication are not the same thing, however. If someone is taking a medication for depression and after a few months there have not been discernible changes, she is unlikely to continue with it. With these meds the proof in the pudding shows up fairly quickly. It takes several weeks to a couple of months for the benefits to fully kick in, though some experience a lift in energy within a week or two.
When talking with a client about the possibility of her going on an anti-depressant medication, I have had to learn to be sensitive to the indications that she gives me that this is a scary area for her. Because from my perspective I can see that meds would give a tremendous boost to her in many of the areas that she chronically struggles with, I have at times been too strident about my recommendation. Some years ago a fellow in my men’s group accused me, mostly in jest though of course reflective of his suspicions and fears, of having shares in a pharmaceutical company. Full disclosure: I don’t. These days I mainly lay the options before someone who comes to see me clearly suffering from depression and try to listen more deeply to the responses she gives me. Recently a graduate student who had been floundering in her work despite clearly being a talented researcher decided to try meds in spite of her initial reactions against the idea. As a scientist she understood all that I said to her about the potential of the meds to bring her out of the malaise of exhaustion and anxiety which was threatening her graduate status. Fear overruled knowledge. I presented it to her then as a scientific experiment: go on a medication for a three month period and be a critical observer of any and all results. Then make a decision to continue or to stop taking them, based on your own experience rather than on things you have read or heard from others. She rose to the challenge and since has gone from success to success not just academically but in her personal life as well.
Some people with whom I have worked over the years resisted the idea of medication as they worked through some of their problems with me but later decided to try it to see if it could help them, for example, with continuing levels of anxiety. The experience of most of these people has been positive. One woman spoke of the sense she had gained of feeling truly herself for the first time in years. It was as though the chronic low-grade level of depression with which she lived kept her in a perpetual state akin to having a cold on a bodily level. The “emotional” cold kept her off her game, feeling always somewhat anxious and troubled by obsessive negative thoughts and self-doubts. Once on the medication she felt clearer within herself and with others, more a mistress of her life than ever before. Others have told me that in retrospect they wished that they had begun medication years earlier. It is likely, however, that the psychotherapy that they had had gave them sufficient security to allow, what had been for them, the risky decision to take a medication and see if it was helpful.
No comments:
Post a Comment