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?
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.”