I think I have underestimated just how hard it can be for people to approach mental health problems from a psychological and social perspective. The longer I work with people who are experiencing severe psychological distress, the more they teach me about the difficulties involved in breaking away from an “illness” mindset. Medications, by and large, are still the mainstay of helping people with psychological troubles despite an increasingly widespread acceptance that psychological problems are not medical problems. Mental illness is an “illness” only in the same way that love-sickness is an illness.
Yet, medication does seem to help some people some of the time. Despite the benefits of psychotropic medication being exaggerated and the harms being minimised, it is the treatment of choice for some. Perhaps the main problem with medication for psychological torment is one of misinformation. Both the people prescribing the medication and the people taking the medication are often misinformed about the benefits of the medication and the range of effects it can have. And, as so often happens in clinical practice, when different combinations of medications at different dosage levels are prescribed, it is probably impossible to know how this particular medication medley will affect the individual who is consuming it.
Medication is often the first treatment option offered to people who access health services for help with psychological problems. People may take the medication that is offered to them because they believe what they are told about the nature of their problem and the potential benefits of medication. It might be a long time before the person questions whether medication is the most appropriate course of action. Some never question that at all. I imagine it is extremely difficult to question the “help” the treatment provider is offering you even if it doesn’t seem to be so helpful.
Healthcare professionals can communicate both overtly and covertly that they are the expert and that their advice and recommendations should be followed. People who want to explore options other than the ones being recommended may feel guilty about suggesting something different, and may be concerned that they will disappoint or offend their treatment provider.
The dynamics of the relationship between the “patient” and the “doctor” can make it very difficult for people to come off medication even when they want to. The people seeking help for their psychological unrest might be working with physicians who believe in the benefits of medication and communicate their faith in pharmacology in subtle and not so subtle ways. These physicians may overtly give support to a person’s desire to come off medication but they might also spend time reminding the person about how long they have had the problem, as well as what happened the last time they tried to come off medication.
When people are on different combinations of medications in different doses it can be very difficult to know what to reduce first and by how much. It is now recognised that dependence can occur quite quickly when people start taking psychotropic medication, and there seems to be a great deal of individual variability in how tolerable medication reduction is for different people. Often, the withdrawal effects of reducing medication can mimic the symptoms of the problem the person was medicated for in the first place (Gotzsche, 2013). This can be interpreted both by the person and the physician as a sign that their illness is worsening, with the solution being to reinstate the medication or perhaps to introduce another medication. An exacerbation of the problem following a reduction in or withdrawal from medication can also erroneously reinforce the idea that the person taking the medication has a medical problem.
It can take a lot of determination, therefore, to persist with non-pharmacological options for the resolution of psychological distress. Psychologically troubled people often have a really tough time just getting through the day. It is a lot to expect them to also be able to doggedly pursue their treatment of choice in the face of professional opposition and resistance. Remarkably, despite all these difficulties, that’s exactly what some people do.
Even if people are able to negotiate the provision of psycho-social treatment, however, they still face further predicaments. Working through problems psychologically can be arduous. It can be really hard-going to explore those things that you have been trying to avoid for so long. Looking at and investigating the distressing aspects of voices and images can be frightening and intimidating. Sometimes things can even seem worse – more confusing or scary – than they did before, while your mind struggles to make sense of its own objectionable activity. Looking at and listening to things that you’ve been trying to ignore, or push away, or keep a lid on for a long time takes courage, hope, and optimism. The benefits are great but it can take sailing a turbulent sea to get there.
The implications of thinking about distress from a psychological point of view in terms of personal responsibility and self-determination can also be confronting for some people. At different times and in different situations it can be comforting to think that this is happening to me, it is not anything I am doing to myself. Yet, the idea of “doing it to myself” is exactly the kind of attitude that a psychological approach promotes. Not in a blaming, critical way but in a “master of my own destiny, captain of my own ship” kind of a way. How could it be anything else? Even though the voices seem like they’re outside my head and even though they don’t sound anything like my voice, they’re still voices that I am generating. In fact, getting to know and understand more clearly the part of myself that is behaving so obnoxiously to other parts of myself is often, either directly or indirectly, a core part of effective treatment.
Grappling with the warring states of one’s own mind can be a tumultuous and baffling experience but one that ultimately leads to certainty, contentment, and wellbeing. Some people might find it easier to keep taking medication and not investigate the meanings and messages they are constantly communicating to themselves. In fact, the very act of labelling these experiences as “meanings” and “messages” conveys a particular perspective. It can be difficult to even accept there is a meaning or a message in the feelings, thoughts, voices, images, and other experiences that seem to be battering a person on all fronts.
A preference between medical and nonmedical approaches to psychological anguish may reflect a balance between short-term and long-term gains. Pharmacological treatments for misery and madness can produce relief in the short-term for the suffering the person is experiencing, yet the long-term benefits are much less clear. Psychological and social approaches, however, do not always have such an immediate calming effect. The full benefits of psychosocial methods are often realised over a longer time frame.
We are steeped in a social climate that promotes a constrained and steady life as the aspirational norm. Any deviation from this is treated as an aberration for which a remedy, often in the form of a pill, should be taken. Experiences that are not happy or upbeat are seen as problems to be eliminated. The manifestation of anger or sadness or dread or zealousness or uncertainty or disorderliness or excitability or moodiness is something to be “cured”. We seem to be living in a strange, “Goldilocks world” where people experiencing “too much” or “too little” of any emotional state are treated with suspicion and are implored to return to a “just right” state. In this world people can even be too happy or too upbeat. Of course what is “just right” is rarely determined by the individual but is prescribed by others.
More and more the health and lifestyle message informs us of a parade of different methods, medicines, and machines for achieving amazing results with minimal effort in almost no time at all. The idea that life can be tough is barely a whisper above the beguiling roar of life as a never ending party where people who are normal are relentlessly chirpy, agreeable, and successful.
The experience of living can certainly provide happiness and success but it can also provide misery, mundanity, mayhem, and madness. Life can be tedious, trivial, and tiresome. All of these things are part of the adventure of living. Questions such as “Who am I?” and “What am I here for?” can often underpin much psychological unrest. These questions, however, do not have quick and easy solutions. Drugs, either prescribed or self-sourced, will not provide the answers. The answers can only come from the individual who is contemplating the questions and, often, the places from which the answers will sprout are those places where the person is most reluctant to look.
Sometimes life can be a toilet. There is no doubt about that. It is not always easy being “clean” in the sense of working through problems and living life with a mind unpolluted by medication. Getting back to “clean” once someone has been taught to cope with problems by creating a medicinal mind-fog can be extraordinarily difficult. It is an inspirational comment on the human spirit that so many people manage to achieve this. The indomitable capacity of the human constitution to reorganize problems and restore balance must surely be one of nature’s most magnificent achievements. It will be a great day when our helping services truly assist this capacity to do what is in its nature to do instead of retarding or obstructing its efforts.
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Gotzsche, P. C. (2013). Deadly Medicines and Organise Crime: How big pharma has corrupted healthcare. London: Radcliffe Publishing.