I’ve been interviewed twice in recent months for articles about how young women shouldn’t feel ashamed about taking antidepressants. The writers had experienced considerable shame about even the idea of taking medication when they have failed to recover with other treatments for depression. They talked to others who described similar experiences- the stigma of admitting that they were seeking help for depression, then the criticism from others about taking medication.
I’ve previously blogged about how much our sense of morality, of what is ‘right’ and ‘wrong’ is bound up in how we both view depression, and its treatment. The arguments go something like:
- If depression is only extreme sadness, why would you ever need to take something for it? It’s a response to what’s going on in your life- sort that out.
- ‘Working things through’ with or without therapy, is the right way to deal with your problems. That’s showing real strength of character.
- Emotional suffering is ‘normal’- we shouldn’t use medication to relieve it. (I might as well have said that suffering is good for the soul…).
If you do believe that depression is only normal sadness, then you will never accept that a pill might help other than to numb or sedate- which is the argument generally put forward. In which case, while being in such a state I’ve managed to function remarkably effectively for the 30 years I’ve been taking them.
But it’s the moral arguments that concern me because of the impact they can have on a person who might already be feeling quite sufficiently ashamed. Shame and guilt are common emotions in depression but shame differs in that while a person might feel guilty about a particular action, a sense of shame is about how they feel about their whole self for committing that action- as Lewis (1971) says:
The feeling of shame is an acutely painful experience because it’s the entire self that is painfully scrutinized and negatively evaluated. Such self-scrutiny leads to a shift in self-perception, which is often accompanied by a sense of shrinking, of being small, by a sense of worthlessness and powerlessness, and by a sense of being exposed.
People with sensitive personalities are more likely to feel shame when they get depressed- as I know only too well.
So if we view ourselves as potentially doing something morally wrong when we take medication, we might not only feel guilty about that, but ashamed too as the act challenges our very self-worth in the eyes of others. This is why the concept of pill-shaming first coined by the activist @Sectioned_ on twitter, is so important. Telling someone who is already depressed how they may be seriously mistaken about taking medication- for the reasons stated above- may potentially make them doubt their self-worth even more and emotional pain – the agony of guilt, shame and hopelessness can and does kill.
There are other reasons of course why antidepressants are problematic. I’ve said many times (and been criticised for doing so) that they did and do help me. However, there are many people they do not help, some people who feel decidedly worse taking them, and many who have difficulty coming off them. None of this is in dispute whatsoever. But I do not think these should be reasons for being ashamed of trying them, as long as that’s an informed decision.
I don’t feel ashamed about taking medication, but that doesn’t stop me feeling angry and conned by pharma companies who have themselves, at times, behaved shamefully.
I did indeed work with Big Pharma during the Royal College of Psychiatrist’s Defeat Depression Campaign 30 years ago by accepting their funding to produce teaching materials about depression. I continued to speak at meetings funded by them for many years afterwards- usually to talk to GPs and/or Psychiatrists about mental health and primary care. I feel naïve that it’s only in retrospect that I can see how, as Edward Shorter puts in, everyone suddenly ‘became depressed’ when Prozac emerged, but at the time, for me, it seemed like the right thing to do. Not least because I saw so many people with unrecognised and untreated depression in my primary care research, and I knew exactly what that felt like. When I joined the campaign, I had just recovered from my most serious episode on medication (an SSRI) that was, for me, much more tolerable than a tricyclic. However, it was only in conjunction with Lithium- which cost pennies (and still does, despite a recent shameful attempt to inflate its price to the NHS) that I made a full recovery. I’ve taken the pills of practically every company I worked with.
Someone said, in one of the articles for which I was interviewed:
“Therapy is what helped me”… “antidepressants were the bridge I used to get me where I need to be.”
I wholeheartedly agree with that. Therapy helped me make sense of my past and present, and regain hope for the future – but antidepressants have kept me going – and alive.
My latest book: Finding True North: the healing power of place discusses how we achieve a sense of recovery in many different ways and is available now.