Don’t Tell Me to Shut Up: The “Et Tu, Brute” Stigma of Mental Illness
After sharing my eccentric journey to recovery in a new book, I’ve been accused of being anti-psychiatry. I’m not anti-psychiatry. I’m only anti-psychiatry if it means questioning the long-term efficacy of antidepressants, drug-biased research and the accuracy of making quick diagnoses without objective evidence. I’m anti-psychiatry if it means campaigning for a better mental health system that views a patient in a broader holistic light and meaningfully addresses things like sleep hygiene, exercise therapy, workplace social capital and diet. I’m anti-psychiatry if it means talking about my horrible experience on antidepressants and how I luckily stumbled on an unconventional path to healing that worked. I’m anti-psychiatry if it means thinking our heavy use of medication, and how fast we jump to medication as a first approach, is dangerous, especially in kids and the thousands of functioning individuals who fall in the middle ground between severe and symptom-free.
By merely telling my story, I’ve been accused of pill-shaming and fueling the stigma against those with diagnosed mental illness who take medication. I’ve been told that my message is dangerous and to “shut up.” This is a bitter taste of irony, because now I, and anyone else who has a story in which psychiatry or prescribed drugs aren’t the heroes, are being told that our stories aren’t wanted. Our stories can hurt people. Our stories are the regurgitations of bitter, uninformed, daft activists. I’d call it reverse stigma, but since we’ve also experienced symptoms of mental illness, it’s more sinister. It’s an Et Tu, Brute moment. The Et Tu, Brute stigma. Questioning the effectiveness of drugs and current clinical practice doesn’t fit the mainstream advocacy narrative, so shut up.
An individual doesn’t wake up one morning and say, “I think I’ll criticize a drug today!” Usually it’s because the person has had a negative experience or witnessed a loved one go through one. Enduring criticism doesn’t follow positive experiences. The person may then independently research the drug and seek out an alternative form of treatment.
While a medical student, a psychiatrist hastily put me on an antidepressant that made me worse. I found the side effects barely tolerable. The dry mouth, the lack of sex drive, the sleep issues… and worst of all, my emotions felt like shoes stuck in gum. I felt leashed in the sense that I was incapable of experiencing great sadness, but also incapable of experiencing great joy. I didn’t feel less depressed, I felt more nothing. Still, I continued to take the medication because a psychiatrist, an expert, told me I would feel better, but it would take time. After several months, I didn’t feel any better and started looking for other alternatives. I also started researching the drugs through publicly accessed databases. Only then did I become informed. Only then did I learn that they could increase suicide and violence, induce mania and were most effective for severe cases of depression.
I’m grateful I stopped taking them, because if I didn’t, I’m not sure I ever would have discovered what worked for me, a functioning person with moderately depressive symptoms that grew a lot worse when I didn’t sleep, eat right, exercise and when I felt stuck in an unhealthy relationship or lackluster job.
I was a middle-ground person, and by that I mean a functioning individual with moderately depressive symptoms. Being professionally diagnosed as mildly or moderately depressed may be the most precarious position for a couple of reasons. One, there are no lab values to confirm the diagnosis and two, you might be prescribed antidepressants that do more harm than good. As mentioned above, severe cases fair much better on the medication. It is this middle ground where I feel a lot more can be done to optimize care by viewing and addressing individuals in a holistic manner. This isn’t just true for depression, but anxiety, insomnia, chronic pain, irritable bowel syndrome, PTSD and more. For this to happen, the system, from the top down, needs to change. Unfortunately, most traditional doctors aren’t educated on effective, safe alternative therapies nor are they trained on how to recommend beneficial lifestyle modifications, nor do they have a precise way to monitor effectiveness. In medical school, I didn’t receive one class on alternative therapies or how to “really” get a patient to exercise, sleep better, eat better or improve their social capital. Payment becomes an issue, because many insurance companies don’t pay for alternative therapies or lifestyle modifications, and a lot of folks can’t afford them. In that sense, wellness is a luxury brand. For financial reasons, doctors are under pressure from hospital executives and insurance companies to see as many patients as possible in a fixed amount of time. This is a system that is not conducive for counseling individuals, but is conducive for the quick fix: a prescription for a drug for a specific diagnosis with a specific code that will be picked up and paid for by an insurance company. To understand an individual in the holistic sense requires a lot of time, conversations and observations. It goes beyond conventional cognitive therapy or psychoanalysis. It’s an intense, intimate and dedicated approach that sifts through both the upstream and downstream determinants of health. (And, no, it’s not all “quackery.”) Even if a doctor wanted to do that, most don’t have the time. This isn’t just true for psychiatrists, as general practitioners prescribe a lot of psychiatric medication. In fact, at least one study shows that psychiatrists were more likely than general practitioners to recommend alternatives to medication. Inclusion of trained wellness coaches who are funded by insurance companies is potentially one cost-effective way to improve the system, especially for the middle-ground patients.
Because convention failed me, I ended up on a very bizarre path to healing, somewhat by choice and somewhat by chance. My path was stupid and dangerous, but there was a silver lining. After taking myself off antidepressants because I didn’t feel like myself, I ended up quitting medical school and on a beach across the country, where I met a mysterious handsome man. I thought the encounter would end there, but no. The strange man turned into a weird, intense, obsessive romance. It was manic. Was it mania induced from the medication? I can’t say for sure. The man wasn’t who he said he was, but he did one important thing: He taught me how to fix my mind in the most unusual, drug-free, down-the-rabbit-hole way. While I had to escape him, I don’t regret the experience, and yes, you read that right. It showed me the importance of embracing ambiguity, questioning conventional wisdom, not seeing the world in black and white, nor viewing people as bad or good, nor picking and choosing what I want to hear and see to fit my narrative of the world.