Introduction
A surprising dichotomy of viewpoints seems to arise around the topic of psychiatry and management; the first is that psychiatrists are real doctors and psychotherapists are quacks. The second is that medication is for suckers, weaklings, and the desperate. The polarization I’ve observed about these topics is surprising considering all evidence seems to indicate that both work pretty well together. While it’s not my place to tell people they must be on medication (As in, legally I’m not allowed to), I can certainly tell you about my experience with medication as a supplement to psychotherapy, and why it may make sense to consult with a psychiatrist about your needs.
1. Step Outside the System
Our personalities and individual psychologies are complex dynamic systems. Our character structures consist of many forces, mounting pressures, levers, sources of friction, algorithms, contingencies, etc. that come together to create an overall feeling of goodness or badness of some kind. The important point about our personalities being systems is that they seem to favor repeated, stable, and predictable outcomes, regardless of how good these outcomes feel.
When these systems create toxic emissions, uncomfortable temperatures, aversive noises, and require a lot of reactive interventions, it can be confusing as to whether or not the system is broken, or that’s simply just how systems are! In other words, the pain and suffering created by our personalities can often be hidden in plain sight, like water to a fish. Why is this hidden? Well, because our brains are too powerful. We learn to adapt and habituate. We get to work on adjusting to the system rather than questioning if it’s broken or not.
No matter how many times it’s explained or otherwise conveyed to us that something is not working, the difference between addressing the issue and continuing the exhausting work of adjusting our behavior and/or expectations often comes down to experience. Humans quite frequently need to feel differently in the world before they can actually see that the whole damn system is broken. This is exactly why:
a. Substance abuse is both so rampant at the same time it causes so much suffering; and
b. Psychiatric medication can be such a powerful tool in psychotherapy*–not only as a temporary relief but as a lasting force for good.
Let me say it more succinctly. Once we know and can accept the scope and scale of a problem, we are much better positioned to fix said problem. In the world of film, two well-known depictions of being stuck in a system are The Matrix and The Truman Show. The popularity and the acclaim received by these films may be partially attributable to the way in which the blind spots they depict are a core feature of human experience.
2. Get More Out of Psychotherapy
Psychotherapy is difficult. I often see the look in clients’ eyes that they would rather be almost anywhere else. Some even say so. Depressed people, almost by nature of the condition, feel it’s hopeless to be in therapy, and sometimes give the impression that working on ending the depression is getting in the way of the client being left alone to sit in his/her depression.
“And I don’t understand why sleep all day
And I start to complain that there’s no rain”
-Blind Melon “No Rain”
Anxious people often worry the treatment won’t help while simultaneously worrying what the therapist will think or say if s/he voiced these worries. Paranoid people fear the therapist is trying to do harm, possibly by humiliating the patient after s/he discloses all of his/her darkest secrets. Traumatized people similarly feel that they will be retraumatized. Etc., etc.
You see, the very nature of mental illness is such that collaborating with a therapist puts us face to face with the worst of our symptoms. Medication provides a tool to make thoughts, feelings, anxieties, disorganized thinking less threatening to the work of really looking at what hurts with a relative stranger.
Medication is not a “cure,” nor is it the longterm solution to lifelong problems. But, medication can be a great tool. As one of my mentors once said: “I’ve never seen an antidepressant relieve a conflict.” That is, medication won’t fix the engine, but it could get you to the repair shop.
A two-pronged approach is especially important since psychiatry requires much patience, collaboration, as well as many adjustments to get the right concoction. Psychotherapy and medication management often need to work hand in hand just to get a patient into a position to begin meaningful work on him or herself. With both psychology and psychiatry, each component should contribute to the efficacy of the other. When mood improves, anxiety goes down, or mental clarity goes up as a result of a psychopharmacological intervention, the therapy benefits. Conversely, therapists can be extremely helpful in counseling patients through the waiting and trial-and-error approach that medication management often requires.
As a therapist, my bias is that the long term solutions to depression, anxiety, personality disorders, trauma, and other mental health problems, is to work with a psychotherapist. Medication has the potential to create the conditions necessary to fully engage with a therapist. With observable changes from medication, the patient begins to realize that a different experience is possible. Once someone believes they can be happy (again), s/he will bear almost any pain to make sure they get all the way (back) there.
A lot of patients object to psychiatric referrals, often rationalizing that they “don’t take pills.”
Underneath this explanation I believe is a feeling that pills are “cheating.”
Medication is not a fix, but it can be an amazing tool. Therapy is the work, but meds can help. pic.twitter.com/sgIvG9Un8i
— Michael Kinsey, Ph.D. (@mindsplain) May 19, 2020
3. Stop Unnecessary Suffering
Suffering can almost take on a moral aspect to it if endured long enough. A strange logic takes hold that because suffering has descended upon us alone, that we alone must either bear or overcome it. Of course, this is absurd if we take a moment to identify, observe, and challenge such an assumption. Our suffering serves no one.
A quick proof: Perhaps someone somewhere would like to see you punished. Your suffering will do nothing for this person, since it’s unlikely that s/he will even know that you are suffering. This punitive individual may conclude that you have not suffered enough, based purely on an inability to:
a. know that you suffer; and
b. Be sated by the suffering you do endure.
And so even in this case, your suffering is useless.
However, if you believe that redemption, moral or otherwise, follows dragging yourself out of an emotional funk by finding your own solutions, then medication (and possibly not even therapy) is not likely to appeal to you. As someone who is inspired by the idea of slaying psychic dragons, I also believe that there is no easy solution, and freedom only follows blood, sweat, and tears. However, I also believe that we do not need to go slaying dragons with our bare hands. Think of psychiatric meds as a sword. And once you’ve picked up that sword, you can then talk to your therapist about why the hell you tried to fight a dragon with nothing but your bare hands.
4. Instill Hope
A well-known finding in the mental health field is that some of the most dramatic improvements in mood come between booking a therapy appointment and attending said appointment. Why do these benefits occur? The most plausible interpretation is that taking action instills hope in the actor.
Skeptics and material reductionists interpret this and other common factors in psychotherapy, like the therapeutic relationship, to mean that effects of psychotherapy are little more than placebo effects. But I think the importance of hope contributes to psychotherapy the way the mantra “I think I can” helped The Little Engine Who Could. Hope, whether it stems from taking action, seeing an impact from psychiatric medication, or the confidence of an effective therapist, is necessary to accomplish any great feat. With mental illness, where an absence of hope can be so central to the experience, the more vehicles that exist to help patients viscerally experience that desirable future can be had, the better.
Antidepressants and other psychiatric medications, because they have the potential to work after a few days, weeks or months, can provide an invaluable morale boost to someone who has long suffered with psychiatric symptoms. To sum up the importance of hope in psychotherapy, the following proverb comes to mind: “whether you believe you can or you can’t, you’re right.”
5. Lift the Fog
We have discussed the fog of negative mood, but there is another kind of fog that can interfere with treatment. That is, the fog of impaired cognition. When we are anxious, depressed, traumatized, obsessed, or embroiled in unstable views of ourselves and others, we can’t think clearly. Our attention span shortens. We take the path of least resistance. We’re distracted. We can’t hold multiple things in mind. We make more mistakes and the downward spiral continues. In the same way that boosting your mood might give you the hope to finally address your mental health, so too can thinking more clearly help to inspire corrective action towards mental health problems, and make better use of your time with a therapist. Psychiatric medications have the potential to make thinking more lucid and give us more access to mental resources. Over time, good psychotherapy will expand these benefits as well as protect against these mental capacities from becoming depleted once more.
Conclusion
When it comes to psychiatric medications, no shortage of negative opinions exist. However, most of these opinions are inherently linked to the bad attitudes of a select few bad psychiatrists (just as though there is a distribution of bad, average, and great cashiers, cobblers, lawyers, mailmen, etc.). Many find the approach of prescribing a pill for existential problems to be dismissive. Others balk at the idea that it will alter some essence of their character, or make them lose control, or worse still, become dependent on something.
I think these objections are unfounded, and that most of these critiques can be addressed by underscoring that psychiatric meds are an imperfect, but useful tool to help people solve real problems of living through some other means–most likely in psychotherapy. Psychiatric meds are extremely useful in helping people step outside of their mental illness, get more out of psychotherapy, stop unnecessary suffering, lift the fog of clouded thinking, and instill hope.