Does This Pill Still Come With A Stigma?

For many, tak­ing med­i­ca­tion for mental health is­sues is a last re­sort or a guarded se­cret. Why? And is it time we opened our minds?

Women's Health (South Africa) - - CONTENTS -

For thou­sands of women, mental health meds sure do

The doc­tor al­ready had the pen in her hand, ready to start scrib­bling Roisín Dervish-O’Kane’s way out. For months the jour­nal­ist had been trapped in a vac­uum, swing­ing be­tween spin­ning-top anx­i­ety and hol­lowed-out de­spair. “She lis­tened as I spoke – the first time I’d told any med­i­cal pro­fes­sional about this – then she di­ag­nosed anx­i­ety and de­pres­sion,” says Dervish-O’Kane. “She said I had op­tions: cog­ni­tive be­havioural ther­apy (CBT), coun­selling – or would I con­sider a month’s course of an­tide­pres­sants? She told me they could help me feel calm and more able to cope within three weeks. I po­litely de­clined and said I’d wait for the CBT. Why? Be­cause tak­ing the med­i­ca­tion felt like giv­ing in.

“Of course, I wouldn’t have felt like that if I’d had a mi­graine or a chest in­fec­tion. But as we know, when it comes to our health, we ap­ply a dif­fer­ent set of cri­te­ria to our minds than to our bodies,” says Dervish-O’Kane. In South Africa, where the life­time preva­lence of com­mon mental dis­or­ders among adults is roughly 30 per­cent, you’d think we’d be more open about tak­ing pills for nig­gles of the mind. Pharma Dy­nam­ics says over one mil­lion South Africans are on some form of an­tide­pres­sant – and that’s a con­ser­va­tive es­ti­mate, since that’s for the pri­vate health­care sec­tor alone. But the Mental Health And Poverty Pro­ject re­port (MHaPP) found that when it comes to mental ill­ness, neg­a­tive per­cep­tions are ram­pant. “You hear peo­ple talk about how they are afraid of work­ing with a per­son with a mental ill­ness be­cause you never know if they are just go­ing to flip off,” one pol­icy maker is quoted as say­ing in the re­port. It’s not sur­pris­ing, then, that the work­place is where se­crecy thrives. In a 2015 sur­vey, 32 per­cent of peo­ple who took time off for their de­pres­sion didn’t dis­close the rea­son to their boss. Aside from wor­ry­ing about be­ing judged, part of the com­plex stigma around mental health comes from within. For Dr Peter Kramer, au­thor of Lis­ten­ing to Prozac, med­i­cat­ing mental health is still taboo be­cause it falls be­tween two ideals. “On one hand, peo­ple may think, ‘You should just be stronger and you shouldn’t need to take a pill,’’ he ex­plains. “Then on the other, peo­ple see med­i­ca­tion as a par­tial treat­ment and they would rather talk to some­one to find a deeper, more pro­found res­o­lu­tion.” It’s not hard to see why mental health is­sues and their treat­ment are viewed as some kind of per­sonal fail­ing that needs to be over­come. From child­hood we’re ex­pected to have this ab­so­lute power over our feel­ings: “Cheer up.” “Pull your­self to­gether.” “Stop cry­ing.” In­sid­i­ously, this idea that the way we feel is merely a mat­ter of choice is fed to us; that it re­ally is mind over mat­ter. Di­alling up the in­ten­sity on our self-scru­tiny is the re­lent­less In­sta­gram-fu­elled zeit­geist of pos­i­tiv­ity, which dic­tates that true hap­pi­ness comes from con­nect­ing with your au­then­tic self. No won­der, then, that a pill promis­ing to al­ter how you feel seems like a bit of a cheat. “Af­ter all,” says Dervish-O’Kane, “When I want my legs to look good in shorts, I’ll do more lunges and eat less pasta rather than wash down a fat-loss pill with an XXL mug of slim­mer’s tea. So I ap­plied the same logic to my mind.” But, of course, this isn’t the same thing at all.

WILL THIS TURN ME INTO A ZOM­BIE?

An­other part of the stigma comes from the side ef­fects of an­tide­pres­sants, es­pe­cially the no­tion that you’ll go from feel­ing dread­ful to sim­ply feel­ing noth­ing. The thought ter­ri­fied Jenna Lee, when, at 25, her de­pres­sion de­scended to the point where she’d spend whole days ly­ing, un­show­ered, on her couch. “I was wor­ried about an­tide­pres­sants turn­ing me into a zom­bie – and I couldn’t stand the idea of be­ing re­liant on some­thing,” she re­calls. Then came the sui­ci­dal thoughts. “I knew I had no choice then.” Jenna re­luc­tantly started tak­ing 20mg of flu­ox­e­tine (bet­ter known as Prozac), a com­monly pre­scribed an­tide­pres­sant. But rather than white­wash her emo­tional ca­pac­i­ties, flu­ox­e­tine en­abled Jenna to bet­ter ac­cess them. “Within three weeks I felt calmer, more able to change what I wanted in my life – and more able to ac­cept what I couldn’t.” And many of the scary head­line­mak­ing as­so­ci­a­tions be­tween an­tide­pres­sants and, oh, heart dis­ease, di­a­betes, bipo­lar dis­or­der – are just that: as­so­ci­a­tions. Ex­perts have re­peat­edly dis­missed any causal links. And the ef­fects of med­i­ca­tion can be so lifechang­ing that 50 per­cent of peo­ple who take an­tide­pres­sants will stay on them long-term. One per­son who re­fuses to ac­cept the shame of mak­ing that choice is ac­tress Amanda Seyfried. She re­vealed that she’s taken an

an­tide­pres­sant to man­age her ob­ses­sive com­pul­sive dis­or­der for the past 11 years and has no plans to stop: “What are you fight­ing against? Just the stigma of us­ing a tool? A mental ill­ness should be taken as se­ri­ously as any­thing else – if you can treat it, you treat it.”

WILL I HAVE TO BE ON IT FOR­EVER?

Char­ity worker Zoe Es­cott, 25, has a sim­i­lar at­ti­tude. She has suf­fered from mul­ti­ple de­pres­sive episodes since she started univer­sity, aged 18, and, af­ter a par­tic­u­larly bad bout of post-natal de­pres­sion, was also pre­scribed the drug flu­ox­e­tine. She de­cided to come off the med­i­ca­tion when she felt sta­ble but, six months later, the de­pres­sion was back. “That’s when I ac­cepted that I needed to stay on this med­i­ca­tion. I tell my­self that it’s no dif­fer­ent from us­ing my in­haler for my asthma.” For some peo­ple, it is the short-term solution that Zoe hoped it would be – Jenna, for ex­am­ple, stayed on her an­tide­pres­sants for four years. Mainly be­cause med­i­ca­tion and psy­chother­apy aren’t mu­tu­ally ex­clu­sive; in fact, they can go hand in hand. “In re­al­ity, we see that when peo­ple get the med­i­ca­tion they need, they tend to see things dif­fer­ently, which re­sults in them be­hav­ing dif­fer­ently, and draw­ing on th­ese new re­sources helps them re­cover,” says Dr Kramer.

YOU CAN DEAL, FOR REAL

As for Dervish-O’Kane? “It took nine months from my first ap­point­ment to ac­cept that I needed to take med­i­ca­tion – and an­other 12 to stop feel­ing bad about it,” she says. “Be­cause chang­ing wider at­ti­tudes starts with chang­ing how you judge your­self. And the ‘jour­ney’ is not nec­es­sar­ily lin­ear; I’ve re­cently raised my dosage af­ter a blind-sid­ing dark patch. Three weeks in and I am, on the whole, okay,” she says. “I’ve bel­ly­laughed and ex­pe­ri­enced the warm sense of re­lief that tells me I’ve done the right thing. Tak­ing med­i­ca­tion may not be what I per­ceived as the ‘per­fect’ way to deal with my mental health – but the idea that such a thing even ex­ists is il­lu­sory. I’m see­ing the doc­tor in a fort­night to dis­cuss my progress. Will I stay on my med­i­ca­tion long-term? Right now, I don’t know. But I have learnt that if I need it for six months or six years, that’s fine, ac­tu­ally. And hope­fully, I’ll con­tinue to be fine too.”

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