Related to last week’s post of the Newsweek happiness article is an essay by Charles Barber in the Feb. 10 issue of the Washington Post entitled “Message (Not) In a Bottle: Healing a Troubled Mind Takes More Than a Pill.”
Again, just like I respect Sharon Begley for raising some concerns in her Newsweek article, I applaud Barber for addressing problems in today’s psychiatric world—that too many people are overmedicated, and that a large number of patients rely solely on pills to cure them, putting their doctors in charge of their health. I have been there—with Dr. R. who prescribed 14 different medications in three months, in whom I placed all of my trust because HE WAS THE PROFESSIONAL.
HOWEVER, it has been my experience and many others—including Kay Redfield Jamison’s—that you can’t begin to start the cognitive behavioral work, or the meditation, or the yoga, or any other aspect to your recovery until you have reached a stable place that comes with meds.

Barber debunks this theory with research from Larry Davidson, a Yale researcher of recovery from severe mental illness. Writes Barber:

As I’ve learned, both professionally and personally, social context is critical to recovery. In other words, there’s invariably a social reason to get better. This is what has been largely overlooked by the “medical model” of treatment, which proposes that you must stabilize a person with treatment (typically drugs) before they can be put back in their social roles or environment.
Larry Davidson, a Yale researcher on recovery from severe mental illness, has examined the data and found that this model is flawed, at least in the field of mental health. “In the medical model, you take a person with a mental illness, you provide treatment in the hopes of reducing symptoms, and then they’re supposed to approximate some notion of normality,” he told me. “Our research shows the opposite. You take a person with a mental illness, you then reduce the discrimination and stigma against them, increase their social roles and participation, which provides them a reason to get better in the first place, and then you provide treatment and support. The issue is not so much making them normal but helping them get their lives back.”
Davidson’s contention is supported by the provocative finding by a number of researchers that schizophrenia outcomes are better in developing countries, where, generally speaking, patients get more support from family and society, and where ill people are less likely to be excised from their natural communities.

I agree with Barber that the extra support from a family goes a very long way in treating a mentally ill person. The psychiatric nurses gave me the same sermon when I told them that I didn’t have anyone else who could help me take care of the kids when I was so ill. Had I lived in another country, I would have had a better chance of being able to rest and recover, instead of trying to do so while caretaking for kids.
But I’m pretty confident hanging out in bed or with my family would have been a waste of energy without the drugs. In that five months that I tried any and all alternative therapies to replace my pharmaceuticals—from acupuncture to massage therapy to Chinese herbs—I could not stop shaking and averaged about three different suicidal plans a minute. Without the right combination of Lithium and Zoloft, I couldn’t meditate, count my blessings, or work on cognitive-behavioral worksheets. Because I couldn’t stop shaking, I literally had trouble feeding myself.
I guess Barber and I hang around different crowds, because I vehemently disagree with him here:

In 2006, an astonishing 227 million prescriptions for antidepressants were dispensed in the United States — up 30 million from 2002. Altogether the United States accounts for about two-thirds of the global market for antidepressants. Other proven and practical approaches to managing milder forms of depression, such as diet changes, exercise or cognitive behavioral therapy, haven’t gotten the attention they deserve in our high-tech zeal for the drugs.

Everyone who I ran into the year of my nervous breakdown preached another alternative therapy that should replace my meds. I was sick of hearing about yoga, craniosacral therapy, fish oil, flower remedies, homeopathic concoctions. No one but my guardian angel, Ann, and a older few friends told me that I might try to use what little energy I had to finding a better doctor.
I disagree with him here, too:

Antidepressants can be highly effective, particularly for the more severe forms of depression. But when you speak to people with severe mental illness who have gotten better, you learn about the reality of the recovery process, which is rarely about a pill — even if that pill is effective. When you interview patients about how they got better, they hardly ever cite Prozac or Zyprexa or lithium. For that matter, they rarely cite a particular doctor or therapist or treatment program. Rather, they talk about a person who was kind to them when they were really down; they talk about the child they wanted to be a good parent to; they talk about God and spirituality; they talk about something that brought them pleasure even when they were cloaked in pain. Many of these reasons to live — the reasons to seek treatment in the first place — are highly personal and idiosyncratic, as was mine.

Because the three people in my life who had been through their own very severe depression—my friend Michelle, my aunt Gigi Gigi, and my guardian angel, Ann—preached a message similar to my doctors: find the right drug combination, and the rest will follow.
Maybe my experience is unique, but my doctor has never, ever told me that pills will cure me. She exhausts the help of cognitive-behavioral therapy, talk therapy, and every other kind of help that will buttress my recovery, like a HappyLite and the right kind of Omega-3 supplement. She applauds my exercise program and the energy I’ve invested into forming a thriving support network online.
Barber articulates an important message in the following paragraphs, but I’ve never, ever considered myself “cured.” Like any other chronic illness, my depression can go into remission–and I might be able to enjoy months or years without symptoms–but I don’t expect it to disappear forever. Writes Barber:

Another thing patients will tell you is that recovery exists, or can exist, within the context of illness. In other words, recovery doesn’t mean cure. It means living with the illness, managing it and getting better within certain limitations. “I define recovery as the development of new meaning and purpose as one grows beyond the catastrophe of mental illness,” says William Anthony, director of Boston University’s Center for Psychiatric Rehabilitation. “My feeling is you can have episodic symptoms and still believe and feel you’re recovering. It is a matter of moving beyond the debilitating phases of the illness.”
The idea that recovery doesn’t usually mean the removal of all symptoms is a novel and distinctly un-American way of looking at psychiatric illness, and illness in general. The fact remains, however, that most major psychiatric illnesses are episodic but chronic. Recovery involves both coming to terms with symptoms — one hopes in the context of their gradual moderation, but that’s not always the case — and finding a meaningful life in their midst.

I guess my main beef with Barber is that he’s too quick to dismiss medicine as a depressive’s ally in getting closer to sanity. His introductory paragraphs bother me, again, probably because I live in a community that, like Tom Cruise’s neighborhood, shuns those who use medication to treat certain maladies, and especially mood disorders, which, in most cases, are born from a lack of gratitude in one’s attitude. In my circles, people are afraid to confess their diabetes (because they must have caused it with bad thoughts) let alone their depression:

Feeling depressed? No problem, pop a pill.
That’s what more and more Americans are doing these days to quell what ails their troubled souls. The use of antidepressants in the United States has exploded in the past couple of decades, and drugs such as Prozac, Paxil and Zoloft, which didn’t even exist 20 years ago, are household names, almost household staples.
And why not? The television ads make it seem so easy: An agonized man or woman stares listlessly into space or slumps on a bed or couch, holding their head in their hands. Then they take a pill and suddenly morph into a happily engaged and joyous being, back on the job or walking in a park, awash in sunshine, surrounded by grandchildren, a golden retriever nipping at their heels, while lush music plays in the background.
But recovering from mental illness is rarely that simple. I know.
As an optimistic 18-year-old freshman at Harvard in the 1980s, I found myself afflicted by indescribably disturbing and intrusive thoughts that involved repetitious words and irrational fears that I had harmed others. This assault on my mind — diagnosed a few years later as obsessive-compulsive disorder — led me to drop out of two colleges in as many years and made it difficult to hold down a job as a busboy.
That was the low point. After that, I began the long, arduous and at times confused process of emotional recovery. Medication was helpful — as was cognitive behavioral therapy, particularly early on — but what ultimately made the difference, what really made me want to get well, was finding a sense of purpose in my new life, a life that had been reconfigured by illness.
The critical moment in my own recovery was my decision — very unpopular at the time — to work full-time in a group home for people with severe developmental disabilities, young men my age who could not talk. Having been given all the choices, I gravitated toward a place where there were few options. But I intuitively sensed that I would find a new path there. Indeed, I found I was good at the work, and it was therapeutic for me to “get out of my own head” and serve others.

Like Barber, the path to mental health has disrupted and redirected every single part of my life. I do what I do today—write Beyond Blue, and devote all of my energy towards the education of mental illness—because of what I’ve been through. There is immense satisfaction in that, and yes, it’s kept me out of the Black Hole many days.
But this line in his story—“The critical moment in my own recovery was my decision (very unpopular at the time) to work full-time in a group home for people with severe developmental disabilities, young men my age who could not talk”—is dangerous for the person just diagnosed with major depression or bipolar disorder because it reads to me like the false promise of that bestseller “Do What You Love, The Money Will Follow?” I have no doubt wealth followed for the author, Marsha Sinetar. But that’s about it.
Maybe Barber’s depression was more situational than mine. Maybe finding the right course was all he really needed. All I know is that I couldn’t stop thinking of ways to kill myself for a very long time. And when I got on the right combination (number 23), I was finally able to get something out of therapy, to concentrate enough to pray, and to be focused enough to write a sentence. Before Lithium, all of that was impossible.
I know that there are doctors out there that push pharmaceuticals and little else. I stayed with one such “professional” for three months until my body was totally toxic. But there are also ones like Dr. Smith who exhaust any and all forms of alternative therapy alongside meds and tell you upfront that drugs won’t do all the work.
I guess I just hate to see one more anti-drug article when those of us who are fighting for their lives have to use any and all help we can find: therapy, exercise, Chinese herbs, Omega-3 capsules, HappyLites, gratitude journals, fulfilling volunteer work, and, yes, pills. Give them to me. Because FOR ME, Charles, they make all the rest possible.