Anyone who struggles with a mental illness or mood disorder must routinely endure a litany of off-the-cuff, unsolicited feelings, ideas, and proposed solutions from people who fancy themselves doctors at the mere suggestion of mental health. One recurring theme is distaste for medication; to talk openly about your mental health struggles is to come into contact with the widespread belief that taking medication is needless or toxic or the result of some kind of personal failing — as though you’re simply not trying hard enough to be happy and well-adjusted.
Last year, when I mentioned I wrote about mental health in polite conversation with a Lyft Line passenger, he explained to me at length that chemicals in tap water are responsible for the rise in depression diagnoses and that essential oils might help combat the toxins in my bloodstream. And when a former boss found out I was on Prozac and Wellbutrin a few years ago, she warned me to be careful — she’d seen too many of her creative friends go on anti-depressants and “become numb.” When my ADHD comes up in conversation, everyone suddenly becomes a sociology professor: ADHD is a pseudo-medical phenomenon rooted in smartphone culture, they inform me, which means everybody has it, which means no one has it, which means Adderall is poison! (That is, unless they are inspired to tell a boring story about all the Adderall they took in college during exams, or that one night in South Beach.)
More recently, I posted a tweet applauding Mariah Carey for revealing her Bipolar II diagnoses in a recent People magazine cover story, remarking that people with mental illnesses are often doubly stigmatized for taking medication. Within hours, someone responded to me by posting three pages of a study on psychiatrists’ roles in Nazi atrocities.
At 27, a decade into medication for major depression and anxiety, I now just sit quietly during these tirades when they occur in person, and don’t respond when they come from strangers online. The emotional toll of defending my lived reality is too steep, and the chances of shifting views too slim. I’d rather save my energy for The Bachelor, another time-consuming and frustrating enterprise that at least comes with some sort of emotional payoff. Having a mental illness is already hard enough. But then to face this routine resistance to its medical treatment—the pervasive idea that medication is an easy out or a superficial BandAid—makes me, and others, want to be quiet about this stuff. And we shouldn’t: Taking meds has been helped me and countless others live lives they couldn’t have otherwise, if any at all.
The stigma against long-term medication for mental illness is often insidious, framed as well-intentioned concern. But it has serious repercussions: A 2000 study suggested that nearly half of Americans with “severe mental illness” do not seek treatment, for example. According to a 2011 study, a slightly more promising estimated 59.6 percent of people with mental illness sought help. Both studies listed the stigma of naming a mental health disorder as one of the principle barriers to care. It’s even worse for children. “For children, stigma and the ‘culture of suspicion’ it creates are credited as fundamental reasons for the continued, pervasive level of unaddressed mental health needs,” concluded one 2007 study.
Having a mental illness is already hard enough. But then to face this routine resistance to its medical treatment makes me, and others, want to be quiet about this stuff.
A big part of this “culture of suspicion” is rooted in the reckless behavior of pharmaceutical companies, which is well documented. I, too, am deeply skeptical of pharmaceutical companies and the impulse to medicate problems that would be better served by something else. But can’t we make space in our brains for both skepticism of a multi-billion dollar industry devoted to getting more people medicated and belief in the science that deems that medication necessary for so many? And can’t we make space in our brains for problematic over-reliance on medication and the equally problematic—and deadly—stigma of medication for those who desperately need it?
Coverage of mental illness treatment in mainstream news outlets often centers on the horrors—which, believe me, are horrors. In April, for instance, The New York Times published an article titled “Many People Taking Antidepressants Discover They Cannot Quit.” It showcases the frightening, and relatively un-researched, downside to an increased population taking antidepressants long-term: debilitating withdrawal symptoms, ones they weren’t warned about, that make it almost impossible to stop taking the medication. The anecdotes are gutting and relatable; tweaking my medication over the years has come with many of these symptoms. For me, however, the solution isn’t to give up medication altogether—it’s to find a regimen that actually works for me.
There’s a pernicious dismissiveness of those who take medication long-term. The basic idea underlying this belief seems to be: Of course you would want to get off those dang meds. Edward Shorter, a historian of psychiatry at the University of Toronto, summed up this view succinctly: “We’ve come to a place, at least in the West, where it seems every other person is depressed and on medication,” he told the Times. “You do have to wonder what that says about our culture.”
The not-so-sub subtext is: Your depression is a fad. And if you’re medicated or depressed or whatever, your problems aren’t medical – they are cultural, and can be surmounted if you just put your mind to it. But, as Danielle Tcholakian argued in an essay published on The Cut, “For many people, depression is a chronic illness.” Much of the handwringing over the side effects of medication overlooks this fact. “Never once does the [Times] article mention that going off medication is a common cause of death among depression sufferers,” she writes, “that many people, when they start to feel better, forget how bad they felt before, forget that feeling better came from the drugs they were on, and stop taking them; or that for many people, the alternative to the side effects of and dependency on the antidepressants or anti-anxiety medication they take is a feeling I’m fairly certain is worse than death, or death itself.”
I am certain that if I were to stop taking my medication, my symptoms would render me sick and debilitated. I know this from years of experience, but I am still often told that I should just try meditating or join a gym or give up gluten. I’m sure meditating would help alleviate some of my symptoms—I’m looking into it. I just got that app! I’m also sure I would have dropped out of college, or lost any number of the jobs I’ve held since, were it not for the proper, however imperfect, treatment I landed on with psychiatrists and therapists. And guess what: I exercise, I eat fruits and vegetables, I write in my gratitude journal, I hydrate (begrudgingly). I do all the things people suspect might cure me of depressive episodes, which they mistake for sadness, or anxiety, which they mistake for nerves—and I still need pills.
Having dealt with the social costs of taking mental health meds since I was a teenager, I’m no longer rattled by anti-medication stigma I encounter from acquaintances or see on Twitter. But what does rattle me—and poses a significant danger to my health—is when I see this kind of stigma reinforced by mental health professionals. Only now is the mental illness stigma that exists within medical communities starting to get the attention (and concern) it deserves. In a 2017 article published in the journal Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, the sociologist Jean E. Wallace argues that stigma of mental illness "thrives" in the medical profession "as a result of the culture of medicine and medical training, perceptions of physicians and their colleagues, and expectations and responses of health care systems and organizations." Another 2017 study found that mental illness-related stigma, as it exists in the healthcare system among providers, is a massive barrier to treatment and recovery.
Often, anti-medication stigma manifests in the form of what that same study calls “therapeutic pessimism.” “Research consistently demonstrates that healthcare providers tend to hold pessimistic views about the reality and likelihood of recovery, which is experienced as a source of stigma and a barrier to recovery for people seeking help for mental illnesses,” the study notes. Why would you prescribe medication for a condition that seems impossible to control? And if you're skeptical about treatability, wouldn't proposed prescriptions feel a bit like nonsense? As the study highlights, “anticipated stigma from healthcare providers” is a major factor in people’s reluctance to seek help for their mental illnesses.
I do all the things people suspect might cure me of depressive episodes, which they mistake for sadness, or anxiety, which they mistake for nerves—and I still need pills.
Several studies show that one of the main reasons that people who do seek help for mental illness aren’t properly treated is “lack of knowledge about the… treatability of mental illness” among medical professionals. I can’t think of a single other medical condition where decades worth of science supporting the benefits of medicine is dismissed so regularly.
For several months this year, I saw a therapist who consistently dismissed my reliance on medication as an “easy fix” that obscured the real work I had to do addressing the circumstantial conditions—traumatic or otherwise—that make me depressed and anxious. She constantly presented stories of former patients going off of medication as inspiring success stories I should work towards. Eventually, I had to initiate a break-up.
Undoubtedly, therapy can help treat depression, anxiety, and many of the other conditions medication treats, too; in fact, often, the two treatments work beautifully together. But to deny the hereditary, biological component to some patients’ mental health is to perpetuate the myth that mental illness is a phase, or something you can will your way out of with positive thinking and therapy. Research has repeatedly shown that medical treatment paired with therapy can offer the best results for those suffering from countless mental health disorders. That’s what works best for me.
Getting off medication isn’t a big concern (or a realistic aspiration) of mine, no matter how many people who haven’t lived in my body present it as such. Being as healthy as I can be—not as you can be, or someone else can be—is my biggest concern.