Answering the question “what is pill shaming?” seems fairly straightforward: it’s shaming someone for taking pills, usually medication and/or painkillers. Sometimes it is friends or family members who do the shaming. Other times it can actually be doctors who do so. But how does this actually take place? Who is targeted for pill shaming? And is it often more sly than obvious in its occurrence? Pill shaming – myself Back in the day, before chronic illness conditions came to be diagnosed thick and fast and medication became an absolute necessity, I used to shame myself for taking pills. When period pain or a bad headache hit, I would try everything I could think of not to take some pain relief. I would drink lots of water, herbal teas the internet told me would cure period pain, force myself to walk even when it made me feel worse, and try to ignore the cramping, searing or tingling pain coursing through my body. Why? Because there is a perception in society that taking pain relief is a “last resort,” only to be done once all other options have been tried. So I would try my best to tough it out and hold on for as long as possible without swallowing the pain relief I needed. The irony being, in relation to migraine at least, that certain forms of pain relief are actually more effective if taken early, rather than if you leave it until later in an attack. Who is targeted through pill shaming? This is a tricky question to answer. If we believe there is an entrenched belief that pills are wrong in society, then we are all in effect targeted. Whether you take an occasional pain killer for a troublesome back or knee, or take regular prescribed medication for epilepsy or fibromyalgia, nobody is outside this belief. It seems though that those with chronic illness and mental health conditions often bear the brunt of pill shaming. Taking regular medication is the most frowned upon, at least in my experience. As discussed below, we experience a great deal of discussion around our prescribed medication, and it is often suggested we try other measures instead. Aside from the views held by friends, family members and even doctors, the media often reports on the “over-medicated” state of certain groups of people (often young women), for certain conditions (such as anxiety). However, perhaps it is simply that doctors are now more understanding, or recognize more conditions that were previously taboo or dismissed. And so those people with anxiety, fibromyalgia and other conditions that were ignored are now beginning to receive the help they desperately need. How does pill shaming take place? Pill shaming seems fairly pervasive in society, at least from what I can see. There are a number of reasons for it, and ways that it takes place. All of them cause harm, both in terms of mental and physical health, to those who internalise them and don’t treat their conditions as advised by their doctors. Of course, taking any form of medication unnecessarily isn’t recommended and can be harmful. This post certainly doesn’t advocate for taking medication that isn’t necessary for health reasons. What I am speaking of in this post is pill shaming people for taking the medication/pain relief they need to have the best quality of life they can, and that is often prescribed by their medical doctor. A belief that pills are poison or toxic I grew up believing that painkillers were bad. I don’t really recall it being said explicitly, but around me everyone waited to take painkillers until they, in their words, “had no choice.” Underpinning this behavior is often a belief that pain relief will “poison” your system if taken too often, and that it is toxic for the body. Taken in large doses or for extended periods of time not under a doctor’s supervision, some medications can be harmful to the body, no question. Anybody that needs to take higher doses needs to be under appropriate medical care for their health needs. But bearing pain can also be harmful, as A Chronic Voice discusses in a post on painkillers. As Sheryl describes, “Pain is also toxic in equal measure, as it impairs our quality of life, and shrivels us up into a shadow of who we once were. In other words, pain sucks the life out of us.” A belief that taking medication is lazy “You should try lifestyle measures.” “It’s lazy to just pop a pill.” “Have you tried exercise/meditation/therapy?” Perceived laziness seems to factor into pill shaming a great deal. Popping a pill is seen as the “easy option” and those that do so are often described as being reckless and not “putting the effort in” while attending to their health. Medication is seen as a lazy person’s response to health issues. Except the opposite is true, from the chronic illness community I know and am fortunate to be a part of. Many of us take medication for all kinds of different health conditions. We have no choice and need (not want) to take medication to manage our symptoms. The vast majority do this alongside, not instead of, lifestyle measures. My Instagram feed is full of people taking all kinds of steps to better manage their health, going to all kinds of measures that I find awe-inspiring and have so much respect for. There are friends who meditate every day, clocking up a year or two on the HeadSpace app, others who walk, run, cycle, change their diet, and investigate and participate in all kinds of alternative therapies. It isn’t a requirement to do so, and pill shaming is wrong whether a person does yoga or not, but what I am saying is that these women (and men) are not “lazy.” I think all of us work damn hard for our health in all kinds of ways. Taking medication is a part of that for many, and isn’t “taking the easy option” in the slightest. The sly Instagram ads Social media is both a wonderful thing and a more insidious one. It is wonderful in terms of the chronic illness community that supports one another so well. But of course, there is a downside and one of those is a more sly form of pill shaming. Sometimes there are companies who outright shame and tell us that we are harming ourselves through medication, and of course, we should be using their amazing wellness products instead. They use slogans like “who needs pills when you can…” or “before you pop a pill, do this!” Other times it is more subtle. It is posts targeted at those with chronic illness, using the appropriate hashtags and even tagging us too, that tell us we will be “cured” if we use certain products or undertake certain activities. Often times medication isn’t mentioned, but the underpinning message is that their products are all that is required to be well. All of those posts feed into the “pills/medication are bad” line. They support a wrongful societal belief that medication is used by the weak/lazy/uneducated who should know better. But you’re too young to need medication! Health conditions don’t have an age. It feels strange to have to state the obvious, but anyone can have health challenges, from babies to kids to teenagers and all the way through to older persons. Yet I know I am not the only one who has listened as a so-called well-meaning friend or family member tells me I am too young to need medication. As though somehow my diagnosed conditions can be “put up with” until I get old enough to need medication. I wonder what they think the appropriate age is to be “allowed” to take medication? You don’t need all those pills (said by a doctor) Pill shaming comes from many angles, but it almost makes me laugh when it comes from a doctor who should obviously know better. Often, it is a doctor I haven’t ever met before, who knows barely any of my medical history aside from a 60-second scan of my notes, that says outright that I take too many medications. Chronic illness conditions often come along like buses, in twos, threes, up to a dozen, maybe more, in many cases. Medication may be required for a few of those conditions or all of them. So when a doctor tells me I take too much medication I have to point out, through gritted teeth, that I have many conditions, so I do indeed need to treat all of them. I often wonder if they think I should pick the most symptomatic condition and only treat that? Or do I get to treat a couple of conditions without receiving negative judgment? Do I then ignore the medical advice of the other specialist doctors who tell me that I very much need to have the other conditions better managed through medication? What is the impact of pill shaming? The impact of pill shaming ranges from moderate to severe. It means I spent far too many hours in tremendous pain trying to tough it out when I could have found relief. It means that people have increased symptoms that impact upon their day. They miss out on family time, work opportunities, hobbies or just simply watching a favorite TV show while not in pain or with other symptoms. Why do people let themselves experience such symptoms without attending to them through medication? Because, as the term suggests, we feel shame for taking prescribed medication or pain relief because of all the reasons given above and the experiences of pill shaming we live through. That shame can spiral into shame about being unwell in the first place, with misguided beliefs that we caused our conditions, or are deserving of mental or physical pain. The internalization of shame can also result in people refusing to take medication prescribed by a doctor, or not taking pain relief when it is required. This can be dangerous to a far more severe degree. We hear stories often in the news of people not taking prescribed anti-depressants, which causes profound mental health issues. There are people who don’t take medication and then wind up in the emergency room with life-altering, perhaps irreparable, issues. And people who feel such shame that they end their lives. Medication can enable lifestyle measures A great deal of the “pills vs. lifestyle” debate centers on one being “bad” (pills) and the other “good,” virtuous even (lifestyle measures). It’s the lazy vs. engaged and active dichotomy in this approach. What this approach misses though is that medication can enable many of us to participate in lifestyle measures or other therapies to further help manage our conditions. It’s a strategy used by many doctors to help us get the best quality of life we can. To give an example, trying to undertake vestibular rehabilitation therapy (VRT) or any exercise with vestibular migraine was not possible for me until medication controlled my attacks. It was medication that calmed my head down and got me to a place where VRT would be helpful and not actually make my symptoms worse. I imagine the same is true of many other conditions. The saving grace of social media Living with chronic illness is often hard. Really hard. It is hard to live with lifelong conditions, daily symptoms and often pain. What makes it even harder is battling against entrenched beliefs that make us question treatment and make us suffer more. We are surrounded by these entrenched beliefs at every turn. Friends and family who follow societal beliefs to think “popping a pill” is wrong, doctors who question our prescribed medications, and social media full of companies out to try and turn a profit by selling us alternative treatments with a sub-text that pills are a “last resort.” The saving grace, I think, is the chronic illness community that rallies against this. My community supports each other’s choices, calls out and blocks the dodgy companies and joyfully posts the clap emoji whenever I get to have the Botox that gave me back my life after chronic migraine had me stuck on the couch for far too long. I guess it is impossible to get away from pill shaming altogether, as sad as that statement is to say. If you experience it, then discussion is all-important, but sometimes advocating for yourself is tough. Perhaps finding others in the same position will be of terrific comfort. I know it is to me.