Is It Me or the Medicine?

As I reflect on the last five years working in the partial hospitalization program at Tanner, I think of the hundreds of children I have treated and consider the many ways I measure progress. I have conjured up a measuring stick that looks at success very creatively at times; and at other times has very clear, quantitative measurements such as identifying 3-5 angry triggers and 5-7 positive coping skills, etc.  Though at times I have to ask myself: Is it the medicine or is it me?  Of course the answer is that it is both.  Some may say it is neither.  :) But some days I am convinced that we keep patients in the program simply to observe them on the medication, and that no great thing that I bring into my group room or bring into the playspace can hold a candle to what medication can do. 

The thing that concerns me the most, however, is seeing children from age 4+ on medication.  To hear a child say, "I'm behaving this way because I didn't take my medication today" is an incredibly powerless - non-person centered stance.  It takes all of the agency away from the child and gives them something even more crippling: an excuse.  And at the same time, when you have children who are actively psychotic or so ADHD that they can't focus long enough to tie their shoes, you beg the doctor for medication!  As the therapist, it is difficult to help a child understand that yes, the medication is helpful for the chemical processes in the brain, but that they, themselves control their mind - their choices - that they can manage their symptoms with behavior modification.  And that they can express their feelings without fear of becoming overwhelmed by their emotions.  That can be difficult for an adult, much less a child, to understand, or to trust.

It is equally as difficult to explain to an adolescent that no, you cannot self - medicate with marijuana because it is illegal, but you can take this other drug to help with your anxiety or depression or - fill in the blank -  simply because it is not.  But it is still a drug!  It is still a chemical compound you are ingesting into your body to alter you in some way as opposed to identifying your own inner resources to overcome whatever issues brought you into therapy in the first place.

I found myself recently trying to give an analogy to one of my patients about medication vs choices.  I used the example of me taking my blood pressure medicine.  I listed all of the ways that I help my medicine to work.  I take my medication everyday, but I also eat healthy and exercise and I don't smoke.  This very logical, 8 year old child looked at me like I was speaking a different language.  In his world, you have a headache, you take Tylenol, your headache goes away.  You are coughing, you take cough syrup and your cough goes away.  Medicine is King!  And I completely understand the logic.  I, myself, have tried on several occasions to manage my blood pressure without meds.  And so far I have not been successful.  And in the context of full disclosure, I know what it is like to feel like a slave to psychotropic medications.  I started taking Wellbutrin last year, and after about 6 months, I decided that I felt happy on a daily basis, and was therefore ready to  come off of it.  So I did - Cold turkey with no titration- and I crashed hard. After two weeks I was FEIGNING for more Wellbutrin - shaking as I refilled my prescription.   I was mortified when I realized that I was dysfunctional without it.  It was as if I could not imagine any happiness prior to taking it.  And I would think to myself, "surely I have been able to make my own self happy.  Clearly I know how to do this - I teach others to do this!" I did not want to be a slave to my medication.  So, I realized I needed to shore up my positive coping skills and gather 'round my support system and a month later I was able to come off of it.**  But I had to remind myself that it was possible to do this.  That I don't believe people need to be on medication (or for that matter in therapy) for the rest of their lives.  Ultimately the goal is self sufficiency, right? Wellness - or better yet, Healing? Or is the goal to keep people enslaved to the medication?  We live in America, right? 

Mental illness = drugs= a lifetime of cash flow.

 I have a job because people take medication.  Working for a hospital, we are at the mercy of insurance companies who will threaten to not cover a patient if they are not medication compliant.  Or if their symptoms persist, and there is not a medication adjustment - higher dosage or more drugs- then ta-ta!

I have to believe that people can be and should be HEALED - not just engage in capacity building to manage symptoms, but HEALED.  Maybe I am being too idealistic and unrealistic.  Some people may even argue that I am being unfair. These same people may argue that there are certain illnesses - mental or physical - that REQUIRE that people be on medication for the rest of their lives.   I know some of these people.  And I see them taking medication for the rest of their lives because they have bought into the myth that they can't be helped, they can only be managed.  It takes a tremendous amount of faith and will (because it takes more work to do it on your own) to responsibly live a life without having to take a pill everyday.  And as I say that I see the faces of some of my friends who I know have to take medication daily.  And wonder what they will think about me having said this about them.  I do not think for a moment that anybody who has to take a pill everyday is weak.  Hell, I still take a pill everyday.  My hope is that they will read in this my deep love for humanity and desire that we all live a long, healthy and happy life.   I watched my mother suffer and eventually die taking pills everyday instead of being healed so that she could live a long, healthy life.   I have to believe that people living their best life, their healthiest life is possible.  I have to believe that just because there are hundreds of commercials daily advertising the benefits of medication, does not mean that we have to buy into the myth of perpetual sickness.   I have to believe in the true benefits of therapy in order to continue to do the work that I do, as opposed to believing that therapy
is merely an adjunct to psychopharmocology.  I have to believe.  I have to believe.  I have to believe.

             

** It is not advisable that you stop taking medication without first consulting your physician.