Taking Lamictal (or Prozac, or Seroquel, or Whatever)? You Still Have to Deal with Your Shit.

I've recently had conversations with several friends that have me thinking about the way North Americans (and perhaps the English-speaking world in general) have come to define and treat mental illness.

One friend of mine, who has had symptoms of depression for as long as I've known him, is finally considering diagnosis and treatment -- specifically, medication.  He says he has "bad genes".  In his view, I guess, medication will correct the expression of these genes and make him less depressed.

As an example of his "bad genes", he described an incident in which his mother took off for the bar, leaving him sick with the flu and in charge of caring for his two-year-old sister.  Later in the conversation, he made repeated references to his frustration with many of his colleagues, and how he had to "do their work for them".  Hmmm.  Kind of like you had to do your parents' work for them?  How do you feel, by the way, about your mother abandoning you while you were sick?  But he's not interested in therapy.  He just needs help for his "bad genes".

Another friend and I were discussing the current antidepressant backlash over lunch.  She has bipolar disorder, I have depression and ADHD, and both of us have done a shit-ton of work over the years in order to become healthy.  We are both in total agreement that meds, taken by themselves, can never be enough to treat mental illness.

The drug companies have very effectively constructed mental illness as a chronic condition, like diabetes, that can be easily corrected by taking meds.  It would take too long for me to hunt down all the academic studies that refute this, so I'll just stick to my personal experience, and the experience of everyone I've ever known who lives a functional life with a mood disorder.

Medication alone is not enough.

My friend with the "bad genes" may find medication to be helpful, but he will not be truly healthy without some serious therapeutic work.  Let me be clear: I am not blaming or shaming anyone for wanting "quick fix".  It's normal to want to just magically feel better when you're miserable.  And therapy can be hard, painful work.  As organisms, we try to avoid pain.  This is natural.

Personally, medication has given me a "floor" past which my mood can't sink.  In other words, I might feel plenty bad, but I won't be falling into The Pit.  In order to get away from The Pit entirely, though, I had to spend a lot of time in therapy.

Therapy taught me to recognize the traumas from my childhood.  I survived by repressing my fear, my sadness, and my rage.  I thought that meant I had "overcome" these feelings.  Nope.  They were still there, and they dragged me down until I recognized them and expressed them.

I also learned to value my feelings in therapy.  I'm a pretty rational person, and I grew up in a home where emotions were pathologized, and I live in a culture that generally lacks emotional intelligence.  The end result was that by my twenties, I was completely unable to tell you how I felt about anything.  I thought my feelings didn't matter.  I slowly learned that my feelings actually convey very important information.  They tell me what matters to me.  They help me to create a life that helps me avoid The Pit.

Finally, therapy taught me how to recognize depressive thoughts before they led me to The Pit.  I learned that thoughts like everybody's always mad at me or I never do anything right have no basis in fact, and are downright unhealthy to boot.  I learned to have compassion for myself, to recognize all the things I do get right (and there are plenty, actually).

I'm not saying that any of this happened quickly or easily.  I saw a therapist intermittently in college, and then for seven years during my twenties.  It was a long haul, probably longer than a lot of people need, but it's what I needed.  The end result is that my depression has become a manageable condition in spite of its psychotic features.  I still need to take meds in order to avoid The Pit, but over the last three years, I've actually been happy more often than not.

After finishing this post, I found Thomas McManamy's article Thomas Kuhn, Paradigms, and Psychiatry, in which he talks about the "mind" paradigm (psychoanalysis) versus the "brain" paradigm (psychopharmacology) and asks for a grand unified theory.