Guest Post, by Anne
When I went in to a new doctor to refill my Sertraline (Zoloft) prescription, the doctor looked at me with a mix of condescension and pity and asked rhetorically, “you haven´t been able to stop the medication after all this time?” Granted, this was a general practitioner MD, not a psychiatric specialist, as I had just moved and an appointment with a psychiatrist wasn´t available for several months. But, this encounter left me wondering at this perception, even from a highly trained medical professional, that continued use of medication to treat depression was an indication of personal weakness. The encounter left me feeling ashamed and embarrassed, like I had to explain my failure away. But then I got angry. A medical professional has a responsibility to be up to date on the current understandings of disease processes and conditions. A person who is charged with caring for people at their most vulnerable, and who, of all people, should have been well versed in the complexity of the workings of neurotransmitters and their dysfunctions in the body, blamed me for a disease that is standard medical textbook, completely shutting down the possibility of trusting communication. The inspiration for this article stems in part from this experience.
The reality is that he doctor´s attitude reflected a general stigma against mental illness we as a society still have, which perceives many mental illnesses as stemming from a character flaw, and failure to “get off the meds” as a personal failure rather than a medical one. Many people who suffer from depression and other psychiatric conditions do not seek help for this very reason, and suffer needlessly, sometimes for entire lifetimes, when appropriate care and medication could have given them their lives back. People who say they, “don´t want to be dependent on any drug” are conflating the successful treatment of a physiological condition with substance dependency and abuse, or sometimes inferring that people who use psychiatric medication to treat their depression are gullible cash cows manipulated by the pharmaceutical industry. While no medication is perfect and the pharmaceutical industry has its challenges, the reality is that, similar to other chronic conditions, depression and psychiatric illness are conditions that sometimes improve without medical treatment, and sometimes they don´t, much in the same way that some people´s diabetes can be controlled through dietary means alone, while other people must take insulin daily. There is no real difference between the efficiency of mere will to make the disease get better for people with diabetes and people with depression. It´s time we stopped shaming people who need to take medication over the long term for chronic depression and instead rejoiced that some people are helped by medication, as well as focused on the need to create medications that can help more people who are not responsive to the current treatments available.
This problem stems partly from the continued separation, in western allopathic thinking, of the body from the mind. All mental workings are chemical processes. When this system breaks down, illness can result. The differences in physiology and chemistry between people with depression and those without can be temporary, caused by a transient disequilibrium brought about by some jarring incident or life event, or can be long lasting, often stemming from physiological causes. Sometimes the pattern can be seen across generations. For example, my great grandmother had severe depression. The stories passed down to me in our family indicate that, as the lonely wife of a minister who moved to a new parish every few years, she would leave her three daughters unattended while staring blankly out the living room window for hours at a time. One time her father had to be called to come from across the country, summoned by a neighbor who told him “the girls are running wild.” I remember her as the fragile but independent 97 year-old with a four-pronged cane, whose house smelled of vitamins and who had cat clocks and statues everywhere, but she suffered her whole life from what was often debilitating, bone crushing depression.
Despite her struggles, she managed to raise very successful daughters and lived to an old age. Given the prevailing attitudes of the early 1900´s in terms of stigma against mental illness, she probably felt extremely guilty about her depression and chalked her inability to be free of it up to a deep character flaw. However, based on her symptoms, it appears clear that she suffered from chronic major depression, and possibly OCD. Though it seems to have skipped my grandmother, my mother was chronically depressed and had OCD. In addition, I have chronic depression that only subsides with medical treatment and have had major episodes of major depression and OCD at various times throughout my life.
While I have started and stopped treatment with Sertraline various times throughout my experience with depression, the depression, for me, always comes back. If I can one day find a way to be free of needing to take medication, I would welcome it gladly, as it would confer many liberating effects. I would appreciate not having the extra cost of the medication and doctor visits, as well as not having to ensure I have the proper amount of supply along with a doctor´s note when I travel internationally. But I want to enjoy my life too. I´m not willing to sacrifice the preciousness of each day that I don´t feel depressed, that I can work and enjoy spending time with others, that I can be productive, that I feel happy, in order to satisfy a false premise. And I should not be looked at as less for that.