It's World Mental Health Day, so stop stigmatising my pills.

by Philippa Willitts // 10 October 2011, 11:21

Tags: health, medicine, mental health, stigma

A photograph of many different medicinal pills and capsules Today is World Mental Health Day, and amidst the stamping out of stigma and awareness raising there is also a loud and pervasive perpetuation of misinformation. I've already been asked to give money to people 'at risk of mental health', for instance, when mental health is surely the goal - mental ill-health is where it becomes problematic. I've certainly never been asked to donate funds to fight physical health.

Mental ill-health has characterised much of my life, and is frequently far more incapacitating than my physical impairments. I've taken psychiatric medications for 17 years, and that's unlikely to change any time soon. I'm not overjoyed at the sheer range of pharmaceuticals I swallow every morning and evening, but it is far from the most significant aspect of my mental distress. So why do so many people focus on the pills as the problem?

For instance, as part of World Mental Health Day awareness on twitter, a study telling me that women's use of antidepressants is at crisis point keeps appearing. In this, Platform 51's director of policy, campaigns and communications Rebecca Gill, said:

"These shocking figures reveal an escalating crisis in women's use of antidepressants"
I appreciate that their study goes on to explain that they are criticising the practice of prescribing antidepressants in the absence of any other psychological support, the frequently highlighted statistics like, "A quarter, 24%, of women on
antidepressants have been on them for ten years or more" serve only to stigmatise people like me.

Rebecca Gill goes on to say,

"Worryingly, our research suggests that there is still a huge stigma attached to mental health problems. With 1 in 5 not telling their families and 1 in 10 keeping it a secret from their partner, it is clear that women fear they will be judged on the state of their mental health",
seemingly without the awareness that scare statistics about antidepressants contribute to that stigma. Their chosen headline is not that rates of women in mental distress is at crisis point, rather our use of antidepressants to cope with it.

Antidepressants are not the enemy. I agree that appropriate psychological support should be more widely offered, and that medications should be reviewed regularly. However the problem is not with the pills. The problem is the world we live in that makes so many of us despair enough to seek medical help to manage it. It's with the levels of rape, domestic violence, female genital mutilation and sexual abuse that can make live unbearable for so many. World Mental Health Day should not be 'celebrated' by stigmatising us for coping in whatever ways we can.

[The image is a photograph of many different medicinal pills and capsules. It was taken by e-Magine Art and is used under a Creative Commons Licence]

Comments From You

Achille Dunne // Posted 10 October 2011 at 11:43

Excellent post. I have suffered from depression for more than half my life. I'm 29 now. I still keep my depression hidden from most people unless I trust them AND there's a reason to tell them.

I think a big part of the problem comes from the misconception that anti-depressants are "happy pills". Which is a gross misunderstanding. They are ONE support mechanism in the treatment of depression. They merely try and stabilise the biochemical environment of the brain which translates into a stabilisation of mood. They are not happy pills and do NOT make your problems go away.

I also think another problem is the over-diagnosis of various psychiatric and psychological conditions which leads to inappropriate medication. There is too much of a move to medicalise much of human experience and I think that this leads to a devaluing of the conditions in their disease-specific contexts, and the associated treatments.

By this I mean, sometimes it is appropriate to feel depressed or stressed or anxious. These can be the correct responses to certain stimuli in life. And medicating in these circumstances is not necessary and quite likely to be the opposite of helpful.

I still struggle on a daily basis with depression. I accept that I will be on antidepressants for a long long time.

Philippa Willitts // Posted 10 October 2011 at 11:50

Thank you. I'm not uncritical of antidepressants, but people focussing so much on them as *the problem* when they are not is frustrating, and does contribute to stigma.

ffingy // Posted 10 October 2011 at 12:04

I think there is also a problem with underdiagnosis and misprescribing. Over a period of about 10 years I went to my GP several times with depression and anxiety. I was given SSRI anti-depressants, and each time I started a course I would have an extreme reaction, which I put down to as the side-effects listed in the accompanying literature. I persevered with them though. After a decade of this I was finally diagnosed as having bipolar ii disorder; the SSRIs were actually making me hypomanic, and making my bipolar condition worse and worse over time. I am now on lithium, for life, with marked improvements. I wish one of those GPs had asked me whether I'd had any 'up' symptoms rather than immediately prescribe me an anti-depressant which made me suicidal and take risks. Indeed, one whom I'd asked to refer me to a psychiatrist for a proper diagnosis refused to until I'd gone on a course of SSRIs first, despite me telling him I'd done so before without them working. Anyway, needless to say, only nearest and dearest and pharmacist get to know what tablets I'm taking.

Philippa Willitts // Posted 10 October 2011 at 12:08

I know so many people who have had similar reactions to SSRIs, either due to having bipolar or similar, or just because SSRIs can push some people into hypomania anyway. I think because they're newish and more highly promoted, GPs especially can forget that one size doesn't fit all.

Jessica Marie // Posted 10 October 2011 at 18:40

As a mental health counseling graduate student I think that there is one really important thing for people to recognize is that psychotropic meds work like band-aids over skin cancer: they cover up the symptom for a while but do not treat the cause: the cancer. This is why very often people who are on them find after some time they do not work the way they used to: so their dosage is changed or they are put on a new med and the cycle repeats.

Sadly, the current state of healthcare focuses primarily on the meds: which was never their purpose. Their ideal use is to bring someone to the point where they will be receptive and present in counseling sessions, to work on the real cause of the depression. Then, after a certain time the client is supposed to be weaned off of them so that they can work to really get at the heart of the problem and find their way of maintaining their mental health without the crutch or training wheels of meds.

All of that being said: there is a general stigma to anything involving mental health, which is a travesty. It is assumed that to be in the care of a mental health provider you're crazy, or messed up. The reality is that we all have coping mechanisms that don't serve us, we all have a toxic family member, we all have a habit that needs to be changed, we all have something that could be greatly helped with counseling and yet 95% of people will never see anyone for help because of that stigma.

--({*})--
For Women.
For the Love of Women.
www.VulvaLoveLovely.com

Philippa Willitts // Posted 10 October 2011 at 20:08

It's understandable that, as a trainee counsellor, you would see antidepressants as mainly useful to facilitate counselling rather than having any useful purpose beyond that, but it's only part of the story.

Similarly, your view that a person should be weaned off part way through counselling to “get to the heart of the problem” also reflects your point of view as a counselling trainee, but it is not necessarily widely agreed with outside of those circles. It also reinforces the view that antidepressants are somehow numbing or uplifting, meaning that people taking them can't 'get to the heart of the problem' when taking them, which is quite simplistic and doesn't really represent how they work.

Not everybody wants to go through counselling, and not everybody finds it helpful. And for those who do, taking antidepressants while undergoing counselling is usually advisable for people who find that it brings up distressing memories and thoughts. Calling meds crutches or “training wheels” is rather reductive, and more than a little patronising.

kinelfire // Posted 10 October 2011 at 20:15

I've just started back on medication after just over a year of being off them. Over the past 10 years, I been on a good half dozen different ones; in fact my first ones were prescribed *after* I'd seen a psychiatric nurse for talking therapy - my GP wanted to consult with her as to what would be the most appropriate as treatment. Things have changed quite a bit.

What seems to frustrate most of the doctors I've seen is that they would like to offer other forms of treatment but they are barely available; counsellors might only be in the practice one day a week as they go round several in the area, if they're any attached to a practice at all. Waiting lists are at least a year long. You have to be 'in crisis' to be seen immediately, and don't get me wrong; I've been there more than once, but I can't help but feel that it would've been better to not get there in the first place. I would bet the cost of my last 10 years' medications that most GPs and mental health professionals would feel the same.

Sorry, I'm rambling and probably not contributing much to the conversation!

To subtly sneer at diabetics for having to inject insulin would be (rightly) seen as ridiculous, why is it more acceptable to some to sneer that those of us who take MH medications?

Philippa Willitts // Posted 10 October 2011 at 20:21

I agree, counselling provision is frequently pretty dismal and really needs to be vastly improved. If I wasn't already "in" the mental health system I wouldn't get any formal support at all. Thankfully I am, but with all the cuts impending, and one of my services introducing charging, I'm not sure how long it will last. For me, it's a combination of formal support, friendship support, and meds that generally keep my head above water.

Implications that we're somehow selling out, or, like you say, sneering, should have no place. We do what we need to do to survive.

Zarathustra // Posted 11 October 2011 at 08:32

Good article.

When I tell people I work in mental health, I regularly get asked whether I “believe in therapy or medication”. I always think that’s a really weird question. It’s not as if car mechanics get asked if they “believe in” spanners or screwdrivers. If somebody did, then that mechanic would respond that some problems need a spanner, some need a screwdriver, and he needs a variety of different types of each.

Likewise, some people need a certain type of meds, some people need a certain type of therapy. Some people need both. I really don’t get why that’s so different to understand.

Philippa Willitts // Posted 11 October 2011 at 08:42

I really like your spanner / screwdriver analogy! It's so true.

Rachel // Posted 11 October 2011 at 16:14

I'm just coming to the end of a series of cbt sessions for anxiety. I think it's been pretty helpful overall, but I did find getting referred and into therapy a very long process. I think I ended up waiting for about 3 months until there was space for me to start treatment, by which point a lot of the initial reasons had shifted. I understand that that's due to a lack of provision/high use, but it would have been much more worrying if my problems had been more serious or life threatening. I've only ever been prescribed medication for my problems once, because I tended to downplay my problems and not seek help, but I didn't find the medication very useful to me personally.

Regarding the stigma surrounding it - not only do general attitudes about mental health issues prevent me from telling people about my problems (even when it would probably help them to understand why I can be a bit weird), but I think that I actually had internalised those views and that prevented me from seeking help sooner. I didn't want to be like those weak people who couldn't deal with their problems on their own and had to dump them on other people, which is obviously a view I don't take now!

Chloe Miriam // Posted 11 October 2011 at 17:11

As much as I have my problems with meds, and still do, I get so unebeliveably angry when people (often people who have not suffered from MH issues ) implying that meds are the ;easy way out' or I'm somehow weak for taking them. I take medication to manage a medical condition, why is that so problematic for so many people?
I also agree with kinelfire, often meds are the ONLY option or a 'temporary' help while you wait 6 months or more for a short course of therapy. I have been revolving in and out for this cycle for years, I'm currently coming to end of my current bout of counselling as I'm only allowed 6 sessions, maybe one or two more at the discretion of my counsellor, and for someone who has suffered depression off and on since I was in my mid teens (no formal diagnosis till my mid 20s and I'm still not sure I have anything more than 'some sort of depressive disorder' written in my notes) it's just not enough. I had to fight to get anything that wasn't CBT too, as I'd tried that and it didn't work and there is seemingly little else offered.
I am even considering going private, which as a skint, unemployed socialist I find abhorrent but I feel I'm left coping with this on my own and have got the bare minimum of 'help' from the NHS. I think the longest anyone has seen me to do a proper, in depth assessment was about an hour about 5 years ago and I feel a lot of my concerns are brushed aside, I see my pysciatrists for about 5 minutes every three months or so.

After all this, which is not unusal, I get even more angry so many people with mental health issues are tagged as 'not doing enough to help ourselves' ... This is even more relevant as claim forms for benefits such as DLA are very intrusive into what treatment you are undergoing and afaik, they can refuse you if you are not deemed to be undertaking sufficent treatmeant to manage your condition.

violetrose // Posted 11 October 2011 at 21:24

Thank you. I was hoping to see more articles on mental health here. Mental health issues such as depression are more common than certain strains of cancer, and yet I still don't feel comfortable telling people I have depression and I need support from them. You're either crazy or you're not really properly ill, and you should pull yourself together. So it seems anyway.

I've always been baffled by the persistent view that meds are handed out like Hallowe'en candy - for myself, and for everyone I know who suffers from mental health problems, we were repeatedly told that drugs were only prescribed if the condition was considered severe enough, and . I'm young (18) and I wasn't prescribed drugs until four years after I first went to the doctor about my depression. I'm still advised to use CBT and therapy as my primary means of coping. And really, why is the use of drugs always seen as a negative thing by the media? You use drugs for coping with other illnesses. I think it's because of the "Hollywood stigma" of mental illness (and I could write a whole feature about that, believe me).

Though hey, my pills have "BJ" written on them, which makes me snigger like a schoolboy every time I take them. Maybe that's how they cure depression.

Summer // Posted 13 October 2011 at 12:34

My friend takes antidepressents which certainly help her, however in the case of her depression the cause is not unknown and relates back to childhood trauma, but she refuses counselling on the basis that she can cope with the meds-something her doctor is trying to get her to assess by prescribing and also doing counselling. My sister on the otherhand cannot identify just why she is depressed and only the pills help, counselling was a complete waste of time and frustrating for her. I think when it comes to over-medicating, counselling and whatever is offered to the patient that it should be tailored to said patient and readily available. Though with the cuts who knows if it will happen. The stigma surrounding this whole area should also be removed, whether the help is medication and/or counselling or something completely different I do agree with the person above's analogy involving Diabetics and Insulin.

Antidepresents (and other medications) are stigmitised and ccertainly in the case of antidepressents not only presecribed for those who are depressed. I'm currently wrestling with the idea of taking what my doctor says is an extremely low concentration antidepressant that is very good for IBS sufferers. I do suffer horribly with IBS but due to the stigma of antidepressants and the 'horror stories' I've heard around them (scaremongering) i've never considered the option, I think maybe reading the comments here and the article, I may go back to the doctor and do some research into the one he wants to prescribe me, alongside some general research with my sister. Thank you for the article.

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