On drugs and mental illness

It’s funny how fast times change. When I was a kid in school, I didn’t know anyone who was on Ritalin. Acronyms like ADD and SSRI hadn’t entered the public lexicon yet. The only psychopharmeceuticals I had heard of were Valium (from the movies) and Haldol (from a novel I’d read). I remember how astounded I was when I discovered that my first college roommate took Prozac. Someone my age who seemed normal. Gradually, pills of all kinds were trickling into the mainstream. Now I am familiar with lots of them, from talking with friends, family, coworkers, you name it. I can easily rattle off several names – Lithium, Lexapro, Effexor, Paxil, Wellbutrin.

I’ve felt varying responses to the drugs that seem to have flooded American life. I know people who have said that these medications save their lives and make them normal and whole. I know others who have had or have tales of very bad experiences. In one case, I recall the trials of a friend whose parents chose a pharmacy as an answer to the emotional troubles of a dysfunctional family and the pain of being a teenager instead of you know, just talking about things or at least sending the kid to a therapist.

This kind of thing troubles me. Being a teenager is supposed to suck. And coming through all that pain and awkwardness is sort of a rite of passage to adulthood. It’s not a medical problem. And I doubt medication could have helped me deal with the social awkwardness and confusion at that time in my life. It could have, however, dulled my ability to deal with it adequately. I’ll never know – I did zero drugs in high school; I didn’t even drink alcohol. But nowadays the establishment seems to be a little less gung-ho about medicating teenagers for emotional trouble. Any mention of Prozac now carries the following disclaimer:

Antidepressants increased the risk compared to placebo of suicidal thinking and behavior (suicidality) in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders.

I guess it ultimately troubles me that more and more, the response to even minor mental or emotional trouble (including PMS!) is to medicalize the problem, rather than recognize the complex forces at work on a person’s psyche. Or simply: if you’re sad (or anxious or shy or hyper), pop a pill.

There was an interesting story on NPR a few weeks back about how playtime for children has changed so much in the past several decades. Over time most children have less and less time for unscripted, improvised play, spending time rather with the television, with toys that do not require imaginative use, and at supervised “enrichment activities” like piano lessons and karate classes. Researchers have found that “time spent playing make-believe actually helped children develop a critical cognitive skill called executive function. Executive function has a number of different elements, but a central one is the ability to self-regulate. Kids with good self-regulation are able to control their emotions and behavior, resist impulses, and exert self-control and discipline.”

Could there be a causal relationship between loss of free playtime and a rise in ADD? If this is even possible how can we respond by drugging our kids? Just because we don’t have the time to really work on the actual problem?

The week before that NPR story came out, I happened upon an article in the Washington Post (while sipping the second yummiest* hot chocolate** I’ve ever had). The article was by Charles Barber, a lecturer at Yale University, who very eloquently expressed my sentiments on mental health. I recommend giving it a read.

I absolutely think that medication is appropriate to treat some mental illnesses. But I also think we have found that even with straight-up physiological conditions, a holistic approach to illness often results in more lasting health. I think this is especially true for mental health. Our ability to function mentally is tied to things like finding meaning in our lives and having supportive people to care for us and foster growth. And it’s also important to understand the mechanisms in our daily lives that lead us towards or away from a healthy mental state.

The film A Beautiful Mind is a wonderful example of how one can learn to cope with a pretty major (and frightening) mental illness. John Nash had delusional paranoid schizophrenia, and he learned how to live with it, found meaning in his life, and had a supportive family to cling to. Yes, it’s a movie, but the real Nash stopped medicating for his schizophrenia from 1970 onwards.

Just some food for thought.

To inject some levity into the subject, I offer you the music of Jonathan Coulton (who is playing at the Birchmere on Friday!)

Jonathan Coulton – I Feel Fantastic [mp3]


[I chose to edit this piece, because well, I just didn't like it as it was.]

* The yummiest hot chocolate I’ve ever had was from Butler’s Chocolate Cafe in Dublin. They had handmade marshmallows.
** I recommend The Lucy – semisweet hot chocolate infused with chipotle.

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