Psychiatric Medication: My Take on the Debate
Every so often, a story on the difficulties of psychiatric medication withdrawal or the dubiousness of antidepressant efficacy will pop up in the New Yorker or some other “professional” magazine or newspaper. Each time this happens, a debate will spark up on Twitter and other social media sites between pro-medication and anti-medication camps. The pro-medication camp will claim that stories such as this are irresponsible, since medication helps many people and anti-medication positions can sometimes have a “pull yourself up by your bootstraps”, individualist undertone (see: Thomas Szasz and those who still positively cite him). The anti-medication camp will be thankful for these stories, as the people in this group have often faced trauma at the hands of psychiatry or have had very negative experiences with medication, and they want those stories to be heard.
Who is more “correct” here? As my choice of quotation marks may suggest, I think that this question is the wrong one to ask. Both sides have very fair and understandable concerns regarding psychiatric medication and how it’s brought up in public and official discourse. The true question to examine, in my opinion, is how should we talk about psychiatric medication and services? This, too, requires more nuance than is typically possible on Twitter.
In general, my belief about psychiatry is that it is historically rooted in the control of the poor and marginalized (see: the history of lobotomies, the practice of diagnosing black men with schizophrenia during the civil rights era, etc). Psychiatry and psychology as social sciences and as structural entities were created within a capitalist, racist, misogynist society and diagnostic practices often reflect this fact. Pharmaceutical medicine, too, was created within a capitalist/racist/misogynist society and as such is motivated by profit above anything else. Psychiatric medicine is not removed from this fact. One blatant example of this is Eli Lilly’s marketing of the antipsychotic drug Zyprexa: while it was originally approved by the FDA to treat schizophrenia and bipolar disorder, the pharmaceutical company eventually also marketed it as a way to treat insomnia, aggression, and unruly behavior in children and the elderly*. This wasn’t done because new research pointed to the drug being helpful in these regards: it was done because schizophrenia and bipolar disorder are limited markets, and corporations are motivated under capitalism to expand their markets and thus their profits wherever, whenever, and however they can. Drugs like Zyprexa are also far more likely to have serious side effects, such as extreme weight gain, diabetes, and eventually, loss of some motor control.
All of this information might make one assume that I am wholly anti-drug-treatment: but I’m not. As I mentioned in a past essay, I understand that use of psychiatric medication is often a pragmatic solution: definitely not perfect, but better than nothing (I personally use Adderall to get my not-optimized-for-capitalism-brain through the day). With that said, that pragmatism works best when the person seeking treatment understands the risks involved with taking psychiatric drugs (potential side effects, drug interactions, and withdrawal symptoms): an understanding that might not be found simply by asking your doctor (as the first article I linked makes clear).
The chronic distress we currently label “disorders” or “illnesses” is a multifaceted thing. Capitalism is certainly a component of it, as Mark Fisher and others point out: the stresses it induces can definitely trigger, perpetuate, or worsen various forms of mental distress. However, claiming that all mental distress is reducible to symptoms of capitalism is reductive and often makes sufferers of mental distress feel belittled and misunderstood. There will, unfortunately, still be traumatic experiences in a post-capitalist world, and people’s brains will react to them in various ways. Some sort of assistance for this would still be necessary, but it won’t look like the treatment options we have today, and that’s a good thing.
While debating and analyzing the causes for mental distress is very important, I believe an even more important step for the time being is analyzing the ways in which the psychiatric system fails us whether we’re pro or anti medication. Psychiatrists and doctors often fail to correctly implement treatment based on their own diagnostic standards (as documented in the first article I linked), it is extremely difficult to obtain any sort of treatment if you have no insurance (in the US) or due to waitlists, and if you’re suicidal, have a personality disorder diagnosis, a bipolar diagnosis, or a psychotic disorder (schizophrenia, etc) diagnosis, you are very likely to receive coercive, unwanted treatment.
Lack of treatment and coercive abusive treatment are both dire problems that need to be solved. Instead of well-meaning people telling others to do some yoga or mindfulness meditation (or to throw out their drugs — something that some people DO do willingly ((by tapering))! but certainly not good as a blanket encouragement) or other well-meaning people telling others to keep quiet about the harms of medication side-effects for stigma reasons, we should recognize that the psychiatric system, capitalism, racism, misogyny, homophobia, and transphobia perpetuate harm on all of us in some way (obviously some of these more than others depending on the person). We should recognize the pragmatic usefulness of medication in a system that doesn’t offer us many other solutions (while also recognizing the negative sides — sometimes serious, depending on the person — of these drugs), and at the same time, we must work towards a world that doesn’t exploit us or expect us to fit a particular personality/mood/emotional type in order to generate profit for capitalists. This status quo sucks, and the ultimate prescription for it has to be its overthrow.
*this article is an AlterNet story, but so old that the original link is dead. the site i linked is just a rehosting of this story.
