“On Prozac, Sisyphus might well push the boulder back up the mountain with more enthusiasm and creativity. I do not want to deny the benefits of psychoactive medication. I just want to point out that Sisyphus is not a patient with a mental health problem. To see him as a patient with a mental health problem is to ignore certain larger aspects of his predicament connected to boulders, mountains, and eternity”
– Carl Elliott
I’ve had a complicated relationship with psychotropic medication.
When I was in college, I spent a lot of time being not-so-gently nudged into therapy by multiple people (my family, my friends, my then-boyfriend who is now my husband). While it might sound odd coming from a now-therapist, I really wasn’t into it. It seemed very weird to be talking to a stranger about my problems (cue ironic trombone noise), and I didn’t like the idea of doing it–it set off major alarm bells with what I now know is my anxiety. But hey, hindsight is 20/20, right?
While I wasn’t in therapy in college, my sophomore year was when I started seeking medication to specifically deal with my fibromyalgia and migraines, and suddenly found myself on a series of antidepressants. I didn’t realize it then, but SSRIs and SNRIs are often used to treat physical conditions as well as psychiatric ones, and that meant dealing with all of the many side effects, some of which exacerbated the very conditions they were supposed to be treating.
Now, working as a mental health therapist for a child and adolescent agency, I often find myself referring clients for medication evaluations with our psychiatrists and psychiatric nurses–sometimes at their request, sometimes at the request of their parent or guardian. In our practice, clients receiving medication are, with some rare exceptions, also required to be in counseling with a therapist. I would estimate that probably about 60% of the clients in our practice take psychotropic medications, which leads to a lot of questions about the nature of how we refer kids for meds, how we decide when they need meds, and what it means to use psychotropic medications on young, still-developing personalities and minds.
I first read David Karp’s Is It Me or My Meds? for a sociology course in college, but found myself drifting back to it a few weeks ago after having a conversation with a teenage client about her difficulty in deciding whether or not she wanted to give meds a try to manage her depressive cycles. Part interview report, part research project, Karp’s text explores the relationship between “pills and personhood”, looking at the ways in which people of different ages, backgrounds, and mental illnesses relate to their diagnoses and prescriptions.
When I read this book back in college, my knee-jerk reaction was almost to recoil. It freaked me out to learn about the ways that psychotropic medications changed the way people think and feel. I didn’t like how easily it seemed that psych meds were prescribed and the high rates of people–especially kids and teens–on multiple meds at once. (In all honesty, this is something that still worries me–the CDC reports that one in thirteen American kids between the ages of six and seventeen takes at least one psychotropic medication, and rates of psych medication prescription soars when kids are involved in the special education, foster, and juvenile justice systems.) That said, even in my first read-through back in college, I could see that Karp is careful to take a nuanced approach to understanding psychotropic medications, and for good reason–Karp discloses in his preface that he himself has taken antidepressants for years, and had spent a significant amount of time struggling with the changes he noticed in himself when he began taking medication.
Reading the book again as an adult and a therapist, I have a different experience. I’m more appreciative of the way that Karp works to understand the entire system of each person he interviews–looking at the whole person, the context of their experiences. In the work I do now, I’d estimate that eighty-five to ninety percent of my clients come to me with a trauma history–some kind of experience of pain or fear that had a significant impact on the way they currently function. I’ve learned the way that trauma can disguise itself as ADHD and Oppositional Defiant Disorder and depression and anxiety, and while I deeply appreciate the ways in which psychotropic medications allow my clients to function while we work through the underlying issues that contribute to their symptoms, I also understand that without the therapeutic component of their treatment, medication alone would not be sufficient to keep most of them functioning.
There’s a reason why the recommended treatment for most mental health disorders is to utilize a combination of medication and psychotherapy. Two of the many medications I take currently to manage my physical chronic health conditions are psychotropic, and even though those meds aren’t prescribed for to treat my anxiety and depression, I’ve found that I do considerably better managing those symptoms when in therapy than I do while taking those same medications without therapy. Is It Me or My Meds? isn’t the most academic or always-engaging of texts, but it is a great read for anyone who is trying to explore the decision to start medication, and I would absolutely recommend it for clinicians who want to improve their insight into what their clients might go through when they make the decision to start–or to stop–psychiatric medication.
Karp’s book asks its main question right in the title, and in all honesty, it doesn’t find a real answer. As clinicians, we tell our clients that medication can help them be the best, safest version of themselves; as patients, we do our best to hope that medication isn’t changing who we are. There is no single experience with psychotropic medication, but each person who takes them makes that decision carefully, and often uncertainly. If nothing else, what I take away from this book–and back to my clients and myself–is that medication is a step on a journey to living as one’s best self.
It’s not the destination.