The Problem With What They Tell Us About Mental Health Medication

When you go into a writing class, they teach you: show, don’t tell. Readers don’t always need you to spell it out. They know anger when they see it, so show them clenched fists and a set jaw. Show them the glare across the room.

In psychiatry, it’s the exact opposite. They tell you things, and all they show you is a small capsule, to which they attach words like “serotonin,” “fix” and “side effects.” They tell you how hard it will be, that it will take time. They say they will see you in six weeks to check in.

The problem is that you can’t show someone a mental illness because it’s different for everyone. Some scream. Some cry. Some do nothing. Some do all of the above in a five-minute marathon, the end of which looks something like this: a scrawny woman in an oversized t-shirt with two-day-old pizza sauce stains sitting in bed, surrounded by balled up, wet tissues. Sure, we can show them the stereotypes: talking to herself, cuts on the wrists, mascara running down her cheeks, but that’s not the whole picture. It’s not honest, and though writers are great liars, we are nothing if not true to the darkest corners of this world. It’s in our nature to show what must not — what cannot — be shown, what people instinctually turn away from. Perhaps that is why I write about mental illness. Perhaps it’s to deal with my own issues, like psychology majors who self-diagnose and treat. Most likely, it’s a mix of the two with dashes of writer’s block and the nagging ambition to “find myself” like most 20-somethings.

It is easy for me to show you my illness, and the illnesses of others I know, because I have seen them. I can paint the picture of a girl surrounded by used tissues, of a boy who bites the back of his hands until they bleed, of a woman unable to breathe on the floor of a public bathroom. For a doctor, it’s more difficult. They can’t show you what you will be like when you take a pill. There are no guarantees, no pretty pictures. So, they tell us, and they hope for the best.

I see a lot of stories entitled “what they don’t tell you about medication” — I don’t know who “they” are or what they leave out, but I’m not sure it’s true anymore. They used to leave a lot of things out. They used to torture the mentally ill, and no one ever told or showed anyone any of that. But today, we talk about mental illness more than ever. Sure, the misconceptions are there. The stereotypes persist. Some people still think that SSRIs are a cure. What I mean when I say what “they” do they tell you about medication is that your doctor makes it clear: here is the pill, here are the side effects, here is what it will do, watch out for this, see you in six weeks. They tell you it might not work, that it’s difficult to find the right pill, the right dose. They — and pretty much everyone on the internet — tell you that it isn’t a quick fix. It’s not a cure; it just makes the days a little easier to take. It eases the panic. It helps you cope with the sadness and apathy. They tell us this, but we don’t know what it will look like, and that’s where the disconnect happens: what they tell us and what we see, though the same, does not sync in our minds, cannot be what it is. We expect an outcome different from what we’re told. We hope, and that’s the cruelest side effect of all.

They tell us what to expect, but we don’t hear it. We only understand it when we go through it ourselves, when we gain eight pounds and stop sleeping, when we snap at our husbands for leaving a dish in the sink. At the beginning, we hope it will make us better, happy, and then the crash comes, and instead of just dealing with our daily dose of sadness or irritability or panic, we now have to cope with out bright, sparkling optimism being crushed, stomped into ashes, blown away by pent up depression.

I began taking medication when I was 20, when I returned from six weeks abroad in London, England where I experienced extreme panic attacks when alone. The city was beautiful. I still long to return, to end my day at a pub, to pick up groceries from Sainsbury’s, to walk along the Thames at night when the tourists are asleep and the shops are closed and it’s as though you are the only living thing in the city. I dream about those nights and the quiet heartbeat beneath the cobblestones. However, I do not miss the panic attacks that came while I weaved through packs of people speaking different languages. The anxiety that came out of nowhere when the burst of wind hit me and the metal screamed as the Tube pulled up to the platform.

My mind, always sensitive and prone to darkness, reached its breaking point. I returned to the States, and the panic attacks persisted. The world was too loud, too bright, too much. My doctor told me it was generalized anxiety disorder, and she gave me medication. I have never felt better than I did in the first month of taking that little white pill. I had energy. I slept and woke up naturally at decent hours. The world was peaceful, fun. The panic was gone.

Approximately eight months later, after face-planting into a hard wall of cold reality and upping the dose twice, I was switched to an SNRI (Serotonin Norepinephrine Reuptake Inhibitor) that we hoped would give me back my libido and help with the hypersomnia that had been steadily getting worse. I upped that twice, too, the last time when I was additionally diagnosed with depression. Now, I’m slowly weening off that and taking  an antidepressant.

They tell you that weening off is the hardest. They explain withdrawal, the importance of following the regime they assign so you don’t get sick. But your stomach still hurts. You head still pounds. You still have panic attacks for no reason at your desk in the middle of the day.

I can show you what changing medications looks like for me: long days of dozing off while typing at work because the 10 hours you got the night before wasn’t enough, not showering because by the time 6:00 at night rolls around the pills have worn off and you’re too tired to move, not having sex with or even wanting to be touched by the love of your life because close contact makes you feel like you’re suffocating. It looks like a woman sitting in bed in the middle of the night surrounded by used tissues in a stained t-shirt. It looks like vomiting because you never feel full, so you eat until your stomach can’t take it anymore. It looks like calling in sick to work because you can’t physically get out of bed and canceling plans because the world is just too much.

They do tell us about our medication. They give us long lists of side effects and instructions. They tell us to come back in six weeks to adjust if needed, which usually, it is. But we can’t understand them because we have this horrible, twinkling hope that the little pill is going to solve all of our problems, and when it doesn’t, we blame them for letting us get our hopes up in the first place. We convince ourselves we were better off depressed and anxious, but it isn’t the truth. We know it isn’t. We’re just tired of crashing.

Unfortunately, there is no simple cure for depression or anxiety. There is no magic pill that will make the world happy and bearable. So, it is up to us to listen, to try and understand not only what the doctors tell us but our own bodies and minds. We have to bear the switches, the weening off and on, the side effects that make us want to sleep forever. If we don’t, we’ll never find relief. We’ll never get better. This is not to say that medicine is for everyone or that doctors are always the most thorough and exact. This is only to say that we are also responsible for our health, for researching and understanding what we put in our bodies and what works best for us. We cannot be shown what it will look like each time we start over, so we have to settle for the telling. We have to be patient, to wait and see what we will look like, because one day it won’t be a girl with dirty tissues. One day it will be a good night’s rest and a healthy meal and a productive day, and just like with the medication, you have to believe me when I tell you that someday, if you stick with it, if you keep pushing through the darkness, you will see a better life.

Editor’s note: Please see a doctor before starting or stopping a medication.

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Getty image via Eugene_Axe