Am I justified in questioning my need for psychiatric medication? Absolutely.
Posted Jun 01, 2014
Once, when I was about nine years old, I ran to my nanny brimming with excitement. At the time, I wanted to be a writer––though I abandoned that ambition through in middle and high school––and I was always obsessing over one idea or another. I really had it this time, I told her. My idea was for a series of books, like my favorite Little House on the Prairie, but my series would be about a family that lived on a cruise ship. Each book would be about a different trip the family took, and the new guests on the ship and their shenanigans. It was gold!
“Kelsey, I have to tell you something,” my nanny said solemnly. “Someone already wrote that story. It was actually a TV show, called The Love Boat.”
In the journalism world––and in other professions, too––this is called being “scooped.” It’s a specific kind of disappointment, one that I had last month when I read Heidi Julavits’ article “Diagnose This! How to Be Your Own Best Doctor” in Harper’s (link works for subscribers only.) I had long wanted to write about Narrative Medicine, a nearly alchemical blend of storytelling, clinical medicine, and therapy, and my sadness at not having gotten there first was just slightly alleviated by the fact that Julavits’s article was fantastic. The spine of the piece was about a middle-aged patient who was suffering from inner-ear trouble, and her quest to receive holistic, thoughtful care, but Julavits also branches out to discuss medical whodunit shows, the Narrative Medicine program at Columbia University, and her penchant for diagnosing literary characters. (I swear that I had the idea for my newest project, The Literary DSM, before I read the piece.) But there is one area of medicine into which Julavits doesn’t venture, and that is psychiatry.
It’s a stickier wicket, for sure, but I have observed personally that a new kind of orthodoxy has developed around psychiatric medications, particularly antidepressants, that begs to be questioned. First, a little background: I was prescribed Zoloft at 15, just before my first hospital admission. The psychiatrist I saw––an old man whom I hated for no reason at all—gave me a sample pack, and I swallowed the prescribed dosage in the car. My mom, from the driver’s seat, was perturbed. “You’re just okay with this?” she asked. I was. There were, as there often are, many reasons for my compliance. On the one hand, I was proud of being medicated. It proved, once again, that I was too delicate for life itself––deeply broken, in the most humble-braggy way possible. On the other, I was so miserable I would have probably done anything anyone had suggested. I stayed on my Zoloft regimen through my hospitalization, but during my outpatient treatment, which lasted about five months, I simply stopped taking the medication. Absolutely nothing happened. It was––and still would be, retroactively––impossible to chart where the depression had originally come from (the malnutrition, or the biochemistry, or the adolescence, or all the above?) and why my mood had ultimately stabilized, though that probably had a great deal to do with being properly fed again.
I didn’t go back on medication until my freshman year in college. Early on in the year, I began sinking further into depression––a really scary kind that makes me shudder to think about even now––but I was also very actively anorexic, which often perpetuates feelings of hopelessness, alienation, lethargy, and so on. I had also become more obsessive than usual about even non-food related items, so my therapist was concerned I might qualify as Obsessive Compulsive, as well. She sent me to a psychiatrist at Saint Vincent’s Hospital in downtown Manhattan (RIP) in November. He told me he didn’t think he ought to prescribe me anything while I was undernourished, because he couldn’t get an accurate read on my baseline personality. The doctor at the hospital where I was admitted around Christmas time agreed. Back at school, months later, though, I saw a new shrink, who gave me a prescription for Prozac. The dosage kept getting bumped up until it reached what is considered a pretty high amount, and it has more or less has remained the same until now, twelve years later.
More than once, however, I have tried to go off it unsuccessfully. In my late twenties, I convinced myself that the unbearable dips in mood I had experienced while detoxing in the past were because I had gone basically cold turkey, and without the oversight of a psychiatrist. This time, with wisdom and maturity on my side, I would do the responsible thing––let a doctor lead––and surely I would come out all right. I went to see the same psychiatrist I’ve had since college, and she agreed that I seemed to be doing very well and we could give it a go. I began tapering off, and then, at exactly the moment when the medication would have left my system, began to feel textbook depressed. I cried on train platforms, in the bathroom of my office, because it was Wednesday, because I had cried last Wednesday. I spent long hours in bed, unable to muster the energy to peel myself off the mattress and go out into the world. I was, at the time, going through my last round of edits on my book, and I began to hate it––the writing, my persona in the book, my personhood, in general––so much that I seriously contemplated canceling my contract, or jumping off the Brooklyn Bridge, or doing the first and then the second. During this period of time I wrote a piece of juvenilia, (juvenilia? but this was not that long ago? you ask, to which I say, the teenage you is alive and well, forever) about the fact that I was going off anti-depressants. Thanks to the Internet, it’s easily findable, so you’d be perfectly justified in reading it, although of course I’d rather you didn’t. Regardless, I said some things in the essay that I didn’t word properly, and revealed some beliefs I have that are unpopular and perhaps untrue (the “perhaps” being because no one really knows much about medication or the brain, yet, despite the feigned certainty of some.) The commenters jumped on me: how dare I question their right to take medication! What hubris, to believe all humans should live medication free! They had diseases with diagnostic codes! How would I feel if a teenage girl, going through a depressive episode, stumbled upon my essay and choose not to take medication to improve her mood because she inferred from my writing that it was wrong?
I do not at all mean to defend this piece of my writing: it’s just plain bad. But I will, however, defend the right to question one’s intake of medication, and in fact say I think that people should do it more often. That teenage girl––the one whose blood is on my hands, according to one commenter––I actually would want her to think twice before she starts to taking medication. As Doctor Doris Iarovici put it in her fabulous article “The Antidepressant Generation," “A growing number of young adults are taking psychiatric medicines for longer and longer periods, at the very age when they are also consolidating their identities, making plans for the future and navigating adult relationships. Are we using good scientific evidence to make decisions about keeping these young people on antidepressants? Or are we inadvertently teaching future generations to view themselves as too fragile to cope with the adversity that life invariably brings?” (For further reading on this, check out my friend Katherine Sharpe’s excellent book, Coming of Age on Zoloft.) The imaginary teenager above is doing all these things: figuring out who she is, dealing with changes in her body, developing a more adult understanding of the world. Of course, she’d want some relief from all these stressors, as I did.
But I think it’s important that she get a little pushback, like the kind my mom tried to give me, rather than follow the happy, bouncing Zoloft ball and dive headfirst into a pharmacological regimen she may never be encouraged to go off of. (I can only say from personal experience and collecting stories from friends that psychiatrists more often than not don’t actively incite this questioning process; Dr. Iarovici, at the end of her article, rightly points out that studies on that, and also the effects of long-term usage, are currently insufficient.) I would want her to really think about it, because the teenager might get to be me, fifteen years later, unable to discern whether the debilitating sadness she feels when abstaining from Prozac is because her brain is flawed, or because it’s just used to all the Prozac, or any number of infinite factors. Or all of these things.
And she might not want to be on medication. What surprised me quite a bit in the comments I received (I shouldn’t misrepresent–-there were nice, encouraging things written as well) was that so many people professed to be perfectly content with the fact that they’d be on medication forever. The fact that I struggled with the idea at all––I struggle with everything, as I was a fabulous Talmudic scholar in a former life––was the point that was most objectionable to them. But their complacency, in turn, frightened me. If they never questioned their use of medication, that means they could be consuming something unnecessary, with undetermined long-term consequences (aside from a depleted bank account, which is a surety.) Perhaps I, or they, were part of the misdiagnosed masses (pretty much everyone agrees that depression is over-diagnosed, but because “the diagnosis of mental disorders can certainly be subjective,” according to Dr. Ramin Motijbai of Johns Hopkins University, it’s basically impossible to prove how over-diagnosed it is.) Or perhaps their depression or anxiety were contextual, and have quietly subsided as they’ve grown older, or had children, or moved to a different city. How would you ever know if you didn’t ask these difficult questions?
My story’s ending might seem to undercut my point: after a few months of white-knuckling it through the day, I made an appointment to go see my psychiatrist at my boyfriend’s urging. I wasn’t exactly worried that I was going to commit suicide, mostly because I didn’t think I had the energy. For the sake of my relationship, and my quality of life, I decided to go back on the medication. I figured that making myself the sacrificial lamb to what I saw as larger flaws in the arena of psychiatry would probably do no good at all, and that perhaps I was failing to see an associative fallacy of sorts in my own thinking (not all medicated people are depressed, but all clinically depressed people should be medicated? Or rather, just because some people are misdiagnosed, does not mean that I am, in fact, one of them.) I’ve been back on my usual amount of Fluoxetine for more than a year since then, without incident. But I will not say that some day in the future, I will once again wonder about an unmedicated life, or even actively pursue one. Stay tuned, as they say.