Hooked on Medication

It’s misleading at best to call psychotropic drugs ‘medication.’ Forty or fifty years ago the ‘medical model’ of human psychology was not merely brought it to question. It was convincingly argued that the parallel between physical and mental conditions was a metaphor that mystified and misled more than it clarified. Though this argument was never effectively refuted, the model that labels problems in living as “illnesses” to be “treated” by pharmaceutical “medicines” dominates actual practice.

The specific term, ‘medication’ carries with it enormous baggage. It locates the problem as being a disease, essentially a foreign process going on within a person that no one, not the person, not that person’s friends, not that person’s parents, not that person’s society, has any direct connection to. Most would agree that there’s benefit in moving away from trying to assess blame, but this doesn’t mean that we can understand human problems without understanding the person who is experiencing the problems.

It is depersonalizing, in fact, to remove the people, from the psychological equation. Guilt and recrimination toward oneself, one’s current relationships, one’s family of origin may serve little purpose. But how can a person’s suffering be understood if we ignore the person’s own thoughts and feelings, the person’s relations to others, past and present?

When we call it ‘medication’ we are also implying that there’s a reasonably precise understanding of what’s wrong and a fairly clear sense of the effect of taking a particular pill. We know that even in physical medicine this is more of an ideal than a reality, but we still think of medication in this way. Even further along idealized lines is the notion that medication, cures the problem, resolves it. This connotation gets attached to psychotropic (mentally active) drugs, despite the rather obvious fact that this is rarely if ever fully true in the case of treatment of psychological problems. Even the Brave New World manufacturers of the array of anti-depressants, anti-anxiety, anti-ADHD, anti-psychotic, anti-whatever-you-say-ails-you drugs don’t claim they cure the illnesses they hypothetically treat, only that they ameliorate the more troubling symptoms. The pharmaceutical companies are nevertheless quite happy to allow this connotation of “cure” to attach to their products. Psychoactive drug advertisements, for example, will warn of side effects, but will never remind potential users that they have no effect on the client’s underlying problems and that any benefits will disintegrate, or even deteriorate, once the “patient” stops taking their drug.

That said, it would be so callous to ignore the fact that alleviation of disturbing “symptoms” can make a world of difference to a suffering persons and those who are close to them. Here the problem is less philosophical and more practical: These drugs act as advertised only some of the time with some of the people, while they may have other impacts that can range from minor to tragic. Sometimes these “medications” exacerbate the problem; sometimes coming off taking them can not only lead to a return of the original problems or even severe withdrawal symptoms. This dependency on taking a psychotropic drug to feel better can increase one’s sense that one is not in control of one’s own life.

There are subtler effects to the hegemony of prescription drugs as the solution to psychological problems. Do youths find their parents’ admonitions against using “recreational” drugs all the more hypocritical because of their parents’ easy acceptance of recommendations to use prescription mood altering chemicals? Does the common attitude of trying first one, then another, then often yet another pill increase depersonalization and make one feel like the object in a biochemistry experiment rather than the subject of one’s own life? Does the drug model (this chemical formula solves this psychological issue) promote a kind of linear, narrow focus, that suggests that deep psychological problems are no more complicated than an infection requiring the appropriate antibiotic?

Perhaps worst of all is the degree to which this focus distracts and detracts from both the use and development of therapy that relies on listening and talking. Many psychiatrists openly lament that, seeing as many as a hundred or so patients per month, it is absurd to believe that they delve deeply enough into their client’s problems do claim to be doing psychotherapy at all.

On the other hand, it is fair to say that “talking therapy” has anything but a consistent record of success. From Freud to the most well-trained psychotherapists today and all the panoply of often bizarre and incomprehensible approaches along the way, the professional of psychology and psychiatry, cannot claim to have developed a methodology, an approach, that is consistently and reliably helpful to persons in deep psychological distress. Evaluation of success, once one recognizes that psychological problems are complex and multidimensional, is difficult at best.

The fact that there are out-and-out charlatans in the field doesn’t help. Certainly neither an advanced academic degree, let alone a self-invented title and shingle, can guarantee that a person possesses the combination of empathy, compassion, patience, understanding of human nature, accuracy of timing, effectiveness of communication, and integrity to help another person live a better life. It is fair to say that this ambiguity leaves the field open to all kinds of abuses, ranging from outright exploitation to the more subtle exploitation of manipulating the client’s dependency to keep them “in treatment.”

The susceptibility of talking therapy to incompetency, to serious difficulties in assessing benefit, and even to abuse, however, does not erase the incalculable value of having someone to talk to who measures up to the task of helping others figure out what’s wrong with their lives and what they can be do about it. Sadly, the domination of the pharmaceutical solution short circuits the pursuit of a deeper theoretical and practical understanding of what goes wrong with us psychologically and what we can do to put ourselves back on the right track. Many institutes and post-doctoral programs continue their work; butm given the vast number of people who need someone to talk to about their problems, the availability, affordability, and reliability of long-term psychotherapy continues to be pitifully lacking.

The effect of this sea change from mid-20th century enthusiasm for talking therapy to the current domination of psychoactive prescription drug “solutions” is also evident in college classrooms. Recently I had occasion to adopt a new text book for a class in Introductory Psychology. This otherwise exemplary text, covering topics such as socioeconomic factors that are commonly ignored or given lip-service only in many current textbooks, nevertheless omitted nearly any discussion of the impact of either early interpersonal experiences or current interpersonal interactions in the discussion of psychological difficulties. Notions of psychodynamics – the interaction of personal experiences and internal conflicts – were presented in a single paragraph as a historical footnote. Then entire chapter on abnormality and treatment was presented in terms of neurophysiology. In some sense, education and popular understanding are a “zero sum game”: As psychoactive “medication” dominates treatment, purely physical understanding of psychological difficulties has all but pushed aside trying to understand psychological dynamics.

Taking this a step further afield, it is not difficult to perceive societal dynamics at play in the movement away from thinking of psychological problems as intimately intertwined with human dynamic toward seeing them as biochemical problems with pharmaceutical solutions. There is, of course, incomparable profitability in linking personal distress with drug sales, a business that enriches both the pharmaceutical companies and their allies. These allies include the HMO’s whose business model depends on functioning on a predictable cost-plus basis. It also includes advertising agencies and their delivery systems, ranging from individuals who haunt psychiatrists’ offices vending their wares as well as the giant media corporations selling time slots on television or “eyeballs” on websites. But beyond this is the insidious role of continually dumbing down the broader public, making them continually less aware of how we humans affect each other, continually more dependent on experts telling us what to think because we could not possibly understand the underlying science, continually more passively accepting of soundbites that pass for knowledge.

This ignorance of human dynamics adds to our vulnerability to simplistic political solutions: Economic problems are the fault of too high taxes, too much government, too many illegal immigrants, too many unionized employees. Some blame may be extended to a few unscrupulous, greedy, and/or incompetent financial industry mavens, but the key element of the game of three card monte is to ensure that only the highly suspect “intelligentsia” ever explore how the system itself is designed to ensure that the economic powers-that-be remain in control of the distribution of wealth and that the consequences of the economic debacle are borne by those at the base of the economic pyramid.

Consider the alternative: If, for example, we contemplate that a children’s hyperactivity may have something to do with their environment, then doesn’t the virtual epidemic of hyperactivity among school children suggest that we need to do invest more in our early education programs rather than cutting them back? If we note at the same time that nearly thirty million Americans take anti-depressants, doesn’t this suggest that something is something depressing about the current state of our culture?

Well, enough for now. It’s time for my medication!