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We have now reviewed many of the medical hazards associated with taking psychiatric drugs. This chapter examines the personal, psychological, and philosophical reasons you may have for limiting or rejecting the therapeutic use of psychoactive agents.
In our workshops and other contacts with the public, we find that most people have a natural aversion to tampering with their brain function by ingesting psychoactive drugs, especially as a method of dealing with long-term problems. And if they do accept prescribed psychiatric medications, they generally want to limit the duration.
People who use recreational drugs do not generally view them as "therapeutic". Rather, they tend to use these substances for relaxation or socializing. Even those people who do take them to relieve anxiety, depression, or mood swings are not likely to consider this a satisfactory solution. Instead, they are likely to see their drug use as a bad habit. Most people feel the same way about using psychiatric drugs, many of which are similar or identical to recreational drugs.
You may wonder if any improvement you felt from taking drugs was caused by the drugs themselves or by personal changes you made in your life. Or you may instead, be feeling worse and worse on the drugs and wonder if they aren't part of the problem. The title of a recent book consisting of in-depth interviews of antidepressant users says it well: Is It Me or My Meds? (Karp, 2006 [220]). In the meantime, your doctor may be suggesting that you need larger doses or additional medications, while you suspect that you need to reduce them or to get off them entirely.
You may believe that being "drug-free" will help you benefit more from therapy or other forms of help. You may also believe that it will help you to feel more in charge of yourself, to evaluate your mental state, to get in touch with your deeper spiritual resources, to live a healthier lifestyle, and to find for yourself what really matters in your life.
You may wonder if psychiatric drugs are causing some of your problems, such as memory and concentration difficulties, headaches and stomachaches, sleep problems, bladder and bowel dysfunctions of various kinds, skin problems, sexual dysfunctions, weight loss or gain, tiredness or apathy, anxious or depressed feelings, irritability and impatience. You may need to stop taking all psychiatric drugs to sort out the causes of these problems.
You may be realizing that psychiatric drugs, like alcohol or marijuana, can interfere with your ability to appreciate your mental condition. Perhaps you are suffering less but at the cost of feeling emotionally or mentally dulled and physically fatigued.
After taking drugs for many months or even years, you may be concerned that they could be doing more harm than good. Having found that there are few studies about long-term risks, you may want to avoid the potential dangers.
You may now suspect or realize that your past failures at stopping psychiatric drugs had more to do with their withdrawal and rebound effects than with your own emotional or psychiatric problems.
If you are a woman who is preparing to become pregnant, already pregnant, or nursing, you definitely should consider stopping all psychiatric drugs. This subject was discussed in Chapter 9. Keep in mind that the absence of obvious deformities in a newborn cannot be considered proof that a particular drug was safe; modern science lacks the capacity to test for subtle kinds of damage to the growth and development of children's brains. Nevertheless, common sense and an elementary knowledge of developmental neurology indicate multiple potential dangers from exposure of the fetus to psychiatric medications.
Similarly, you should make sure that you aren't taking a drug that could damage your genes. In this respect, too, negative test results cannot be taken as proof that genetic damage won't occur. In Chapter 4 we mentioned earlier findings of genetic damage in children following treatment with Ritalin, as well as some experts' suggestion that irreversible sexual adverse effects from the use of SSRIs may reflect genetic damage.
Even if you don't plan to stop altogether, you may want to reduce your medication dose or the number of medications you are taking. As you may now realize, few drugs are approved or fully evaluated in combination with other drugs; so, by taking more than one drug at a time, you essentially become an experimental subject.
In recent years, the National Institute of Mental Health (NIMH) has been collaborating with drug companies to promote psychiatric medications. By calling its campaigns "Anxiety Awareness Week" or "Depression Awareness Week", it gives them a seemingly benign "educational" aura. Meanwhile, the drug companies themselves have helped to finance these activities.
Some of these companies advertise directly to the public to convince people that they are depressed or "bipolar" and thus "need" drugs. Direct-to-consumer advertising of prescription drugs (on television, in newspapers and magazines, and on the Internet) increased by almost 30 percent per year between 1996 and 2001, to a whopping $2.7 billion, and it was estimated to reach $7.5 billion in 200593. As Washington Post writer Peter Carlson (1998) [83] has commented:
"My favorite drug ad is for an anti-anxiety medicine called BuSpar. The headline asks, `Does your life have signs of persistent anxiety?' "
"Of course it does", I replied: "I'm the parent of a teenage girl."
"Unfortunately, BuSpar has some side effects that could tend to cause persistent anxiety - hallucinations, seizures, stupor, rectal bleeding, hair loss, hiccups, and a `roaring sensation in the head'."
The notion that "mentally ill" people need medications is also promoted by drug company-sponsored "consumer" groups such as the National Alliance for the Mentally Ill (NAMI) and Children and Adults with Attention Deficit Disorder (CHADD), and of course by government-sponsored organizations like the National Institute of Mental Health. These groups hold national meetings that bring together drug advocates to talk directly to consumers. They also put out newsletters and other information that praise medications. Sometimes they actively suppress viewpoints that are critical of drugs - for example, by discouraging the media from airing opposing views.
One effective marketing technique involves the attempt to convince people that they now need the very product that has just been created. Indeed, just as clothing manufacturers spend millions of dollars trying to convince people that they need new clothes to remain stylish, drug companies are invested in convincing people that they need psychiatric medications - because they have "mental disorders". This is often called "disease mongering"94.
Some people, when they first hear about a "disease", begin to fear that they are "ill". For example, it's well known that medical students tend to think that they are developing one or more of the diseases that they have read about or observed during their training. Governmental and drug company-driven "awareness" campaigns play on this natural human vulnerability. There is hardly a person alive who doesn't experience moments or even hours and days of anxiety depression, or other emotional "symptoms", making it easy for drug advocates to claim, for example, that half of all Americans will suffer a psychiatric disorder at some time in their lives. In actuality however, these campaigns - including the ones directed to depression and anxiety - are stigmatizing and demoralizing people, who, in turn, end up believing that they must have a mental illness.
Its all a matter of definition - of naming and labeling. When emotional discomfort or suffering is defined as a "disorder", it creates business for doctors and drug companies. The campaigns to promote "mental illness" have been so successful that, within a matter of a few years, millions of Americans have come to believe that they have "biochemical imbalances", "panic disorder", or "clinical depression", and that their children have "ADHD", and bipolar disorder, and oppositional defiant disorder.
As a result of successful marketing campaigns, consumers tend to identify trade names with generic products. We ask for a Kleenex when we mean any brand of soft facial tissue. We ask for a Xeroxed copy when we mean a "photocopy". And we speak of the "Prozac nation" when referring to antidepressants or even psychiatric drugs in general. This identification of Prozac with "antidepressants" has led doctors and patients alike to think of it as their first choice among drugs.
You may have started taking psychiatric drugs because you thought, or were told, that you had "panic disorder", "clinical depression", or some other supposed manifestation of a "biochemical imbalance". Now, however, you may be wondering if you were actually experiencing understandable reactions to stress, disappointment, loss, or frustration in your life. You may have begun to doubt the validity of national campaigns to convince Americans that they are mentally ill and in need of drug company products. And as a part of your growing skepticism, you may be questioning whether you should be taking psychiatric drugs after all.
When you have tried to stop taking drugs, your emotions may have become much stronger than you anticipated. You may have felt as though you were on an emotional roller coaster. Psychiatry and the pharmaceutical industry have successfully defined intense and painful emotions as "illnesses" or "disorders". But intense and painful emotions are better understood as distress signals.
If you were marooned on an island, you might Hail your arms wildly in the direction of any passing ship. You might scream and shout as well. You would probably try almost anything to draw attention to yourself - to compel a response to your desperate plight and your need for rescue. When you express anguished feelings, you are sending emergency signals that need to be heeded, not suppressed.
Phrases like "panic disorder" and "clinical depression" are intended to give a medical aura to powerful emotions. In effect, however, they stigmatize such emotions. They make strong emotions seem dangerous, pathological, unnatural, or out of control. But especially strong emotions are better seen as strong signals, sent by an especially powerful soul in need of new direction or special fulfillment.
Even when you feel overcome or swept away by an emotion, you need not do something right away to stop the emotion. You can learn to have feelings without being driven to do anything about them.
When you suppress strong feelings by rejecting them or by drugging them into oblivion, you essentially blind yourself to your own psychological or spiritual state. You are left to blunder about in the dark without direction. The feelings may later burst out of control in some grossly harmful way. Or they may remain submerged, sapping your strength. And with your distress signals suppressed, you may remain indefinitely marooned or trapped.
Many people have succumbed to the prodrug propaganda barrage. It is hard to sustain faith in ones own judgment when confronted by a public relations onslaught from the pharmaceutical industry organized medicine and psychiatry government agencies, private foundations, and the media. As we noted in our introductions, this tide sometimes seems to be turning, as more and more Americans realize that biological psychiatry has simply not delivered on its promises. Still, selling psychiatric drugs is huge business in America today; and we do not expect a sharp curtailment in the sale of psychiatric drugs in the near future.
When people seek psychiatric or psychological help, they usually fear that their own resources are failing them. Often they feel frightened and helpless in the face of internal conflicts or external stresses. Misgivings and even embarrassment may accompany their decision to seek help. "I wanted to handle my problems on my own", new patients or clients are prone to say.
Often they believe that "there's something wrong inside my head. I can't think straight. I can't control my emotions". Irrational thoughts or feelings may seem to arise out of nowhere, making them feel vulnerable to forces beyond their control.
In psychology there is a useful concept called "locus of control". People who seek help from mental health professionals often believe that the locus of control in their lives lies outside themselves. They may feel at the mercy of their spouse or parents, or even their own children. They may feel helpless in regard to work. Or they may feel overwhelmed and no longer in charge of themselves or their lives.
Too often, all this is made worse when people seek help from a psychiatrist. First, they receive a medical-sounding diagnosis. Often they are told that they have "panic attacks" or "obsessive-compulsive disorder" or "major depression" or "manic-depressive (bipolar) disorder". Immediately this label confirms their feelings of helplessness. The locus of control moves further away into the hands of "the doctor".
Psychiatric diagnosis, a system of thought that is alien to individuals everyday sense of themselves, is imposed from the outside. Being diagnosed implies that the problem is a disorder or even a brain disease inside them, yet totally beyond their control. It's inside them, even a part of them, but they can't do anything about it except to take the prescribed medication. Essentially then, they are being informed that, like a brain tumor, their painful feelings cannot be controlled or modified by personal understanding or efforts. The original feelings of helplessness and "being out of control" are now confirmed by an official medical diagnosis.
Often patients are told, "It's biological and genetic". Never mind that there's no substantial evidence that any psychiatric diagnoses have a physical basis; the pronouncement is made with such certainty and authority that the patients are likely to believe it. Besides, they have heard the claim repeated time and again in the major media.
The process of diagnosis thus takes advantage of patients worst fears about themselves. It confirms self-destructive thoughts about "being out of control", "being sick", "being unable to help themselves", "being at the mercy of forces beyond their control". Intentionally or not, the process of psychiatric diagnosis manipulates the patients feelings of personal helplessness.
Nowadays, a diagnosis is often immediately followed by a prescription for psychiatric medication. Unfortunately the offer of a drug moves the locus of control further away from the individual. It is the ultimate symbolic gesture that places the authority in "the doctor" and, even more impersonally in "the pill".
The pharmacological effect of the drug takes the dehumanizing process another giant step further. The drug impairs mental function, reinforcing the patients sense of feeling helpless and in need of medical supervision. As a result, they become even less able to take charge of their life in new and creative ways.
Biological psychiatry takes advantage of patients worst fear - that they are emotionally helpless. Biological psychiatry further undermines their sense of personal efficacy replacing it with reliance on the doctor and drugs. The locus of control, already shaky in people who are seeking help, is wholly shifted to the doctor. Then, as the drugs impair the mental function of the patients, they become increasingly dependent on the doctor95.
Good therapy or counseling does not reinforce clients' feelings of helplessness and indecision. Instead, and in contrast to the traditions of biological psychiatry, it aims to inspire clients with the capacity to take charge of their own lives. Toward this end, nothing is more important than the therapist's ability to be empathic and caring - to bring a compassionate spirit into the therapy96.
Instead of emphasizing "pathology" or "mental illness", counseling and therapy should empower clients to draw on their own human potential and natural assets. Unfortunately, however, this approach is being corrupted as "talking therapists" increasingly turn to psychiatrists for medical solutions to the problems they face in working with more difficult or challenging clients.
Counselors and therapists should encourage their clients to reestablish the "locus of control" within themselves. They should also strengthen their clients, sense of personal autonomy, self-understanding, and decision making. But these ends cannot be achieved through diagnosis and medication. On the contrary diagnosis and medication push the patient toward reliance on "expertise", on interventions that originate from the outside and lie beyond their control.
When faced with emotional difficulties, we are often tempted to dull or delay our suffering by impairing our brain function. Toward this end, we may use cigarettes, alcohol, marijuana, or other substances. We may exhaust ourselves with work, sex, or sports. Or we may turn to excessive eating or television watching.
By the time we seek help from a mental health professional, we may believe we've been drained of personal resources. We may feel as though we've suffered too much or that we've exhausted our capacity to deal with life or at least with certain important problems. Or we may feel "burned out", as though we've blown a fuse or worked our minds to death. At such times it is indeed tempting to seek a solution that requires minimal mental or emotional work to dull our pain.
Yet this option, despite its short-term attractiveness, inevitably becomes self-destructive. When we are facing a personal crisis, whether acute or chronic, we need all of our brain power, all of our mental acuity, all of our ability to feel and to think. Instead of dulling our pain by suppressing our emotional signals, we need to be more aware of them and better able to understand them. Only then can we adopt better solutions to our conflicts and problems.
Many people intuitively recognize that taking psychiatric drugs can put them out of touch with their feelings. They want to have a clear brain and mind, even if it means experiencing painful emotions.
Drug effects, in lay terms, are "artificial". Many individuals understandably want to learn to conduct their lives without being under the influence of drugs that affect the mind and spirit, creating artificial tranquilization or euphoria.
Taking psychiatric drugs can make it very hard to know what you are really feeling. You may have felt better at first while taking an antidepressant, stimulant, or tranquilizer; but now you wonder if the improvement was due instead to your own personal efforts at improving your life or perhaps to changes in your circumstances or even the passage of time. Or you may feel as though you're getting worse while taking the drugs but you don't know why. Which is the culprit - the drugs themselves or the unresolved emotional problems and continuing stresses in your life? Or are the drugs preventing you from getting even worse than you already feel? Your doctor is likely to tell you that you need an increased dose, a newer drug, or a combination of several medications to help you feel better, but you have your doubts.
When you are taking psychiatric drugs, it becomes difficult to recognize your own feelings and to figure out their source. You may not even know how confused you are about your emotional ups and downs until you stop taking drugs that affect your feelings.
Feelings are the signals by which we guide our lives. If we are happy the positive feeling can confirm that we are on the right track. If we are persistently sad, lonely, depressed, anxious, or angry, the negative feeling can be an important signal that something is the matter. Of course, it can be very difficult to know ourselves well enough to interpret and act on these signals. But without our emotional signals, we are guaranteed not to fully experience or to make progress with our lives.
Psychiatric drugs blunt and confuse these essential emotional signals. Our emotions depend on our brain function, and the brain is an intricate, delicate organ that can easily be thrown out of whack by drugs.
Sometimes drugs give us "false positive" signals, such as an artificial high or euphoria. When euphoric, we may remain stuck in unsatisfactory frustrating situations or take unrealistic or even grandiose risks.
Sometimes drugs give us "false negative" signals, making us feel depressed, disappointed, out of sorts, or even suicidal or violent. Since the tendency is to try to attribute our negative feelings to something or someone, these false negative signals can lead us to take very irrational and destructive actions such as hurting a loved one.
Getting in better touch with our real or genuine feelings is one of the most important reasons to stop taking drugs. The concluding chapter further describes how clients and therapists can work together to overcome emotional crises without resort to drugs.
Faith or expectation plays a key role in how we respond to medications. Regardless of the cause of our suffering or the real effectiveness of a particular drug, most of us feel better for a short time, at least, when we are given a drug that's supposed to be helpful.
Many patients with severe pain due to cancer or to physical injuries feel better for a while after an injection of plain sterile water if they are told it is a pain killer. Similarly, in clinical drug trials, forty percent or more of patients with anxiety or depression commonly feel better when given a sugar pill that they are told will be helpful to them. If the conditions are right - that is, if the patients have a lot of faith in what they are being given - a sugar pill may produce emotional improvement in 60 to 90 percent of patients. This is the placebo effect - improvement that comes from a positive expectation or faith in the drug or the doctor rather than from any chemical impact of the substance97.
The placebo effect can be helpful. The lowly sugar pill, which rarely causes any physical harm but can relieve physical or emotional suffering, has the best risk/benefit ratio in biopsychiatry. The placebo effect also explains much of the effectiveness of psychiatric drugs. However, when an individual attributes improvement to the physical characteristics of a pill, and to the expectation that it will work, that person's belief in his or her own psychological or spiritual power can be undermined. This experience can encourage reliance on the pill rather than on personal efforts.
Drugs like the SSRIs can become souped-up, high-power placebos. They receive so much hype from the media, and from drug company promotionals, that the expectation of help becomes enormous. The anticipation of relief can produce a relief - because of the expectation that we will feel better.
Whether the placebo effect takes place in response to a widely advertised antidepressant or to a sugar pill, it may create the false impression that emotional problems originate from physical causes and the false expectation that chemicals are the answer to personal problems. The placebo effect is complicated but it clearly demonstrates the power that people have over their own emotional state, given the proper encouragement. But people don't know that they are experiencing a placebo effect. To the extent that they think they're responding to the chemical impact of the drug upon their brains, they may become further convinced that control over their lives lies outside themselves and in the medication.
When people mistakenly believe that they are being helped by a drugs chemical effect, they develop distorted ideas about how to live their lives. Instead of recognizing the power of hope, faith, or optimism in their lives, they give false recognition to the power of drugs. Instead of developing more effective ways of living that would provide more genuine, realistic, and lasting results, they pop a pill. Bolstered by the initial placebo effect, many patients go for years trying one and then another pill to meet their needs, rather than improving their lives through self-understanding and better principles of living.
Psychological dependence on drugs tends to undermine our self-esteem, confidence, will power, and sound principles of living. We turn to doctors and drugs instead of more personal resources such as self-insight, personal responsibility, love, family life, creative work, and improved principles or ethics.
As a larger problem, the use of drugs furthers dependence on physicians and on their medical approach to solving essentially psychological, social, economic, and spiritual problems such as feeling depressed or anxious. This dependence, in turn, alienates us from the most important sources of human wisdom, as well as from other human services, as sources of strength and direction.
Advocates of psychiatric drugs often claim that the medications improve learning and the ability to benefit from psychotherapy, but the contrary is true. There are no drugs that improve mental function, self-understanding, or human relations. Any drug that affects mental processes does so by impairing them.
Once again, this principle may be best understood in relation to people who use so-called recreational drugs. Many individuals drink alcohol, smoke marijuana, or take other nonprescription drugs to "get through the day", to "handle work stress", or to "relate better". When people stop using alcohol or street drugs long enough to recover somewhat from their effects, they are likely to discover that these psychoactive substances were actually retarding their ability to handle life. While influenced by the drugs, they mistakenly accepted or adapted to a lower level of mental and social functioning. Now they must learn how to deal with life all over again with a drug-free mind. After many years of impaired functioning under the influence of marijuana or alcohol, they may need many months or even years of drug-free living to learn how to deal with life with a fully functioning brain.
Patients who have been taking psychiatric drugs for years at a time may face the same problems as recovering alcoholics or marijuana users. Under the influence of drugs, they adapted to stress, conflict, and challenge by increasing the doses of these drugs rather than by increasing their capacity to live. And when negative emotions became overwhelming, they dulled them rather than learning to harness them in creative ways. When psychiatric drugs are stopped, these emotions may soon come roaring back to life - but without the experience required to understand and to channel them.
This problem is tragically apparent in children who grow up on psychiatric drugs, such as stimulants and antidepressants, and who may never mature in a normal fashion. Much like illicit psychoactive drugs, psychiatric medications can retard the psychological and social development of children.
The long-term use of psychiatric drugs tends to teach people how to relate at a lower emotional, psychological, and cognitive level. Then, when the drugs are stopped, there is a gradual, growing realization that they have been functioning despite these drug-induced impairments. It can take time and help from others to learn to live with an unimpaired brain and the increased awareness and emotional responsiveness that follow.