“It’s not about pills. It’s about power.” — Caroline Mazel-Carlton
Pill shaming. It’s the next big thing. Media outlets we at least intermittently respect (e.g., Upworthy, BBC) are running right alongside those with which we generally struggle much more (e.g., The Mighty), all calling for its end. But, what is this “pill shaming” thing really about?
Pill shaming seems to be spoken of in two distinct forms:
- The ignorant family and friends who “pill shame” by suggesting someone should just be able to “get over” their distress with improved diet, exercise, or sheer willpower alone.
- The well informed activist who — by virtue of sharing their own drug-free story and/or truths about psychiatry — is said to somehow be tacitly shaming the person who still uses psychiatric drugs as a part of making their way through the world.
These two definitions of “pill shaming” are substantively different from one another, yet similarly misguided.
We say that the first definition of ‘pill shaming’ is misguided because the issue often seems much less about discouraging someone from taking pills, and more about the routine dismissal of their distress overall. In this case, the focus on ‘to pill or not to pill’ is typically symbolic at best. Unfortunately, this view of human suffering as inconvenient above all else is a pervasive one. And, it happens not only among family and friends who want their loved one to “just be okay” so everyone can carry on with business as usual (or ignore some deeper familial issue), but also within the provider system itself. Of course, while in family systems, this may look like a denial of the value of pills because the pills themselves represent an uncomfortable reminder that something’s amiss, it looks quite different on the inside of the system’s figurative walls. Because therein, the best way to deny the validity of someone’s feelings is to actually push the pills to try and wash all those pesky emotions away.
On the other hand, the second version of “pill shaming” is driven by a weird sort of counter-counter-narrative which basically means it’s the same old story packaged up as if it were something new and ultra woke. It’s an at least three-quarters straw man argument that seems to suggest that just by speaking truth about how the system has actively lied to us about psychiatric drugs (and more), that we are somehow now “anti-medication,” and shaming those for whom pills are a tool that seems to work. But, of course, challenging the mythology that human distress is caused by “chemical imbalance” rather than external factors such as poverty in so many instances is not the same as denying that a chemical might make tough conditions more bearable. (For more on the Chemical Imbalance Myth, see: Dear Mental Health Professionals, “Please Stop Defending Yourselves and Listen” by Noel Hunter and “Psychiatry’s Grand Confession” by Jonathan Leo and Jeffrey Lcacasse.)
“We’re not pill shaming you. We’re just sick of watching people fucking die.” — Sera Davidow
Now, to be clear, there are some for-reals pill shaming folk out there. The short-term pill shamers are often the ones so damn excited about their own new found success that they can’t help but preach it to everyone around them. Finding the key to their own success by coming off psychiatric drugs has felt so miraculous that it’s near impossible to believe it wouldn’t bring the same results for pretty much everyone else. This is usually a passing phase (and not much different from those who get super excited about the results they’ve achieved on a fad diet, a cleanse, or a 12-step program) as they either relax into their own process enough to once again become aware of the many other paths that people can legitimately take… or their own process becomes messier as time passes, and their choice — even if still the right one for them — stops seeming like quite the panacea it originally appeared to be. So, they grow quiet, or at least a bit more humble, at that point.
On the other hand, the long-term, super committed pill shamers (a very small group, to be sure) have often been so hurt by their own experience (or that of a loved one) in the system that they’ve become rigid in response. Sometimes, in their heart of hearts, they’re able to recognize that pills are not actually the route to all evil, but they nonetheless see them as problematic enough that they don’t care, and don’t want to risk any nuance detracting from their overall message.
They are the ones yelling that pills are to blame for every last problem that they and others have experienced. If only psychiatric drugs weren’t a thing, we’d all be fine. Of course, it’s not possible for that to be true in any global sort of way. Humans have been using drugs of one sort or another since the beginning of time with varying levels of success and demise. Trying to dictate to others what their experience has been or should be isn’t especially useful in any context. But once again, in truth, this group is so small as to have a nearly negligible effect, although they’re talked about enough these days to suggest they may be lurking with their pill shaming ways in every shadow.
Yes, it would seem that there must be some investment in creating this illusory affect that serves to engorge the reality, and justify all the pressured press. Our best guess is that at least one of the two following factors is typically at play:
- Internalized oppression
- The same old oppressive power structures as before
Internalized oppression is not a new topic. (See, for example: “The Language of Internalized Oppression.”) How it plays out here is this: If you were expecting to inform someone that all they’ve been told about psychiatry, and perhaps even about their own human potential, may not be so true, and have them cheer and thank you, you may be disappointed. Often, they’re going to be angry. You have, after all, just challenged the framework around which they may have been organizing their life for quite some time. Suggesting that all that might be based on lies and half-truths will not uncommonly be met with defensiveness, and at least a temporary increase in their desire to hang onto what they’ve believed to be true. This not infrequently includes some solid ‘pill shaming’ accusations.
Meanwhile, if you’ve taken the recent uptick in ‘pill shaming’ media coverage at face value… Well, think again. Though any real paradigm shift is still a ways off, some progress has been made. Progress — particularly when it comes to undoing systemic power imbalances — tends to illicit a response. This is, at least in part, the system’s efforts to silence its detractors. Calling “pill shaming” quite successfully and immediately shifts the dynamic from that of ‘information sharing’ to ‘victim versus bully’. There’s little that is more silencing than calling someone out for taking advantage of another’s vulnerabilities no matter how untrue. How convenient that some of our own should be willing to take on a piece of that work, too. (But, that’s nothing new.)
Meanwhile, in the effort to lend a hand to our oppressors, there’s an even more troubling phenomenon emerging, especially on the part of accusers of Pill Shaming Type II. That phenomenon takes shape when people speak as if the pill shaming deal is somehow equal to the conventional clinical system’s push to take drugs in the first place. Just a mere incidence of “tit for tat.” Yes. Okay. Sure. Pushing someone in any direction is an issue. As was said in “Mind the Gap: The Space Between Alternatives and Force”: “Force is force, of course, of course.” Yet, force without power doesn’t have much… well, force.
Bear with us as we momentarily digress into the lush land of analogies: We believe that women can treat men badly. Some women have quite prejudicial ideas toward the male species in its entirety, and refuse to give even the “best guys” a chance. Yet, we reject wholeheartedly the idea of misandry. Why? Because “reverse sexism” can’t exist in a society where women simply don’t have the power to systemically oppress men. Yes, it’s been many years since women gained the right to vote (for example), but they didn’t have the power to grant that to themselves. As others have pointed out before us, they could fight, boycott, yell, scream, protest, and use every tactic in their “good activist” books, but it was still the men who had the power to actually change the law. Similarly, it remains men (white men, to be precise) who continue to have the power to rule over women’s freedoms as demonstrated by the recent abortion decision in Alabama and several other states.
There’s also still rape culture, pay gaps, and a host of other inequities with which we continue to contend.
Now, most will be able to recognize that a woman’s ability to be mean to (or even withhold certain opportunities from) an individual man or group of men is simply not the same as men’s power to change the very laws which govern all women’s freedoms. The situation is similar in psychiatry. People who engage in pill shaming (of any kind) can be just as mean, dismissive, and damaging as the next person at the individual level, but they lack any real systemic power. Meanwhile, those who wish to push pills have the media, the doctors, corporate power, and (most importantly) the law on their side. When a family member attempts to shame someone out of acknowledging a problem or taking a particular approach to solve it, it can be very painful, but they are limited in what they can do. There are no court orders that legitimately force people who want to take psychiatric drugs not to take them, or who incarcerate people to keep the psychotropics away. Yet, freedom and bodily integrity are at real risk in the reverse.
Moreover, while one may come across a true-blue ‘pill shaming’ person here and there (they’re definitely easier to find than, say, Big Foot), the “non-compliance” police are pretty much everywhere. They’re in all the media stories (fictional and not) ranting about the dangerousness of “untreated mental illness,” and in the court systems with their commitment orders (both inpatient and out). They’re in the violence of restraints and needles forcibly penetrating our skin. And, to top that off, we’re not allowed to actually call that violence because we lack even the power to define the word from our own perspective. There simply is no comparison.
And, yes. For goodness sake, yes. Some small groups and organizations focused on pushing back against all the power absolutely do center (almost exclusively) stories that support the counter-narrative. This is not a bad thing, provided they don’t simultaneously seek to denigrate other stories in the process. It is not an example of “reverse psychiatric oppression” or anything else nefarious. It is based in the tangible reality that those stories — and the truths they represent — are largely ignored or unheard anywhere else. They don’t owe “equal representation” in a world where those in power offer none. On what planet is it fair for the group with 11 pieces of cake to ask the group with one piece of cake to be the only one to share? And when the latter refuses, how does it make any sense at all to then accuse them of abuse? Let’s remember that the pharmaceutical lobby represents one of the most well-funded and powerful corporate aggregates in the world. Pharmaceutical and health product lobbyists operate on a larger budget than any other lobby in the country, including oil, electric, and guns. And it is certainly unlikely that any board-room discussions at Eli Lilly world headquarters involve deep reflection on how to make space for those whose narrative challenges their bottom line.
“Speaking truth about bad science and psychiatric oppression does not equal ‘pill shaming.’” — Sera Davidow
So, what do we do now? Here’s a few suggestions:
1. Check your own ‘pill shaming’ narrative contributions: Stop writing “pill shaming” pushback posts. Stop ‘liking’ them. Stop sharing them on social media. Stop creating, buying, or wearing anti-pill shaming swag. Stop using the phrase entirely. Even if there’s some piece of the message you like, you’re contributing to a larger problem, so find a different way to address that piece and leave the rest behind. At best, the underpinnings of the ‘pill shaming’ accusation are misguided. At worst, they represent a concerted effort on the part of the current power structure to use us against ourselves, and they don’t need any more help. Seriously.
2. Check your roots: Yes, you can write a critique. And I can write a critique of your critique. And then you can critique my critique of your critique whilst I prepare to critique you back, all culminating in a war of words on some overly academic closed Facebook group. But, at some point, we’ll all have lost sight of what in hell we were even trying to accomplish in the first place. Critical thinking is important, especially when up against a system that has tried to numb and force that out of so many of us. Yet, when we get so invested in making arguments and picking apart ideas, we start to miss out on the reality of people’s lives. These issues aren’t actually playing out in books, or journal articles, or even on social media (no matter how it may appear). This is real life, and we need to remember that one prominent tactic in these sorts of battles is for those currently in power to somehow convince those without much power to fight amongst ourselves. The enemy is not us, but it sure is our lives at stake.
3. Check your agenda: While we truly believe that this ‘pill shaming’ focus is off track and far overblown, too many of us nonetheless do have overly specific ideas about how life should look for other people. The only true path to liberation is to focus on how to support people to get their power back (or get it in the first place), never mind how they then choose to use it. That power may come with or without drugs, and those drugs may be prescribed or not. Our job is to illuminate the many paths, not to push anyone down a particular one.
4. Check your privilege: Sometimes the path someone chooses is because they have access to all the paths, and really want to be on that one. But it’s important to be clear that some people choose psychiatric drugs because they lack the support to get off of them, or the resources they would need in order to take as much time off of work as it would require to taper successfully. Lots of people would love for alternatives like exercise to be the answer, but they lack the time, energy or physical capacity to test it out. And, some people are clear that they’re choosing psychiatric drugs as the best option “for now” because that’s what it takes for them to survive in the rapid-fire city where they currently live, or to get through school, or what have you, and any risks involved are worth taking. These are all valid choices, provided people have real information with which to make them.
On the other hand, effective social justice movements make space for (and center) the experiences of those most marginalized. In whatever sphere we do this work, we cannot forget those struggling on locked units under the weight of forced drugging orders. It is often poor people, people of color, and/or foster children who are most impacted by the narrative that anti-dopaminergic drugs “treat” so-called “mental illnesses.” In reality, the people who most need our movement are often dying of organ failure before they even become aware of its existence, let alone counter-counter-narrative critiques. Somehow we must find a way to navigate this tension and hold all these truths.
5. Check your ableism: And finally, it’s important to remember that people get to decide what “working” or “success” looks like for them. The oft unquestioned definition of success tends to come with a full-time job, no hospitalizations, and a series of relational markers (like marriage, children, and so on). But, we need not be so limited in our vision. People’s lives don’t have to necessarily check all the boxes of a capitalist system in order to be of value. It’s okay for us to be in the world as we are, to self-define what makes our lives worth living, to have our stories be anything but “neat and tidy,” and to forget about all the external expectations that try to tell us whether or not we’re “okay.” It’s even alright to not be consumed with trying to “recover,” especially if that comes at the cost of just getting to live.
And, one last point: Please also remember that those of us who are fighting for change and full recognition of the counter-narrative (the one that says the answer does not always lie in a pill bottle, that the drugs are often causing harm, that psychiatric diagnoses lack scientific validity no matter how much someone’s distress is real, and that loss of power is one of the most important issues of all) haven’t gained enough of a foothold yet to merit the counter-counter-narrative response. Sure, when you see someone being pushy, name it and push back, but the concerted backlash is undeserved and harmful. At least give us a bit more of a head start before you allow yourself to be used as a tool of the system to put us back in our place. Give us a fighting chance.
There are things that are deserving of our collective “shame.” Phenomena like rape culture and the growing inequality of our country are deserving of being called out aggressively and often. And we definitely should not seek to shame people for the strategies that they use to survive this world, whether or not those efforts include a prescription pill, a drug purchased on the street, or engaging in self-injury like cutting or burning. But neither can we afford the distraction of conflating pushbacks on Western medicine’s power to define the narrative with shaming attacks on individual liberty.
Remember, “It’s not about pills. It’s about power.” And we sure don’t have much of that (yet).
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.