Advice from the Trenches: Medicating Emotions

Dear C and Dr. B;

I know that anxiety is considered a psychiatric condition these days, but I remember a time in my life when I had no anxiety at all. I was married to someone who paid the bills, I had health insurance, I lived in a nice home. I could have done just about anything I wanted to. I had little motivation to do anything. While I relaxed, my life was falling apart behind my back. When I got divorced, I was anxious all the time – I had to figure out how to solve all sorts of problems I’d never dealt with before. Suddenly, I was motivated and capable. I was also not at all depressed, which I often was when I was married.

The sense of anxiety hasn’t ever left me but I just use it as an impetus to get my ass in gear. What if I’d gone on anti-anxiety meds when I got divorced? What are both your opinions on this whole “emotions are a disorder” phenomena that seems to be sweeping the country?

Anxious Abby

Dear Abby,

There are two different issues here. What you are describing is the normal anxiety that anyone would feel in a dire situation. It is called being human and alive. This isn’t a psychiatric issue and shouldn’t be medicated. However, a constant sense of dread and despondency that has no visible source, or that is out of proportion to the environmental stimulus, is another story. This can be a condition that benefits from medication. Unfortunately, in our culture, most people seek medications for what are really just normal human emotions.

Anxiety is a necessary part of the feedback mechanism of the brain that tells you to say no, get out of there, or stop doing whatever you are doing that is making you ill. It is also part of common sense. The bigger issue I see is the unrealistic expectations that dominate the field of psychiatry today. Too many people are on some kind of psychiatric medication. The commercials on TV promise that pills will make problems go away. It’s a promise that can’t be delivered.

Psychiatric medications do not, in reasonable use, make you “happy” and can’t permanently erase your anxiety. Marijuana, ecstasy, cocaine and alcohol, are far more efficient than any psychiatric medication to either numb your emotions or cause temporary elation. The purpose of psychiatry is not to remove your suffering or uncomfortable emotions, but to help you to transform those experiences into something meaningful and useful. Psychiatry is supposed to help you to provide context for your suffering. Our current culture had led us to expect a life with no suffering at all. Be careful what you ask for – many psychiatrists will, at your request, keep medicating you to the point of oblivion. If that doesn’t work they will plug you into a wall socket and eradicate your memory.  It is our current paradigm – the promise of an end to suffering!

Dr. B

C: While I agree that there is a difference between normal emotional reactions to stress and conditions that are so acute they prevent a person from functioning, I just don’t agree that psychiatric medication is the best way to help us to “transform experiences” or “provide context” for our suffering. In an ideal world, perhaps that’s what psychiatry should do, but right now, psychiatry is symptom-based and it seeks only to erase those symptoms as cheaply and efficiently as possible. Half of psychiatric meds are prescribed by doctors who have no background in psychiatry at all. Unfortunately, Dr. B’s intent in his own practice does not reflect the experience of the majority of patients seeking medication.

Absolutely everything in our economic system encourages the misuse of psychiatric drugs,, and media programming is infested with commercials that brainwash the public into pressing their doctors for a prescription. The doctor gets paid, the pharmaceutical companies make money, reality shows and police dramas continue and everybody’s happy. Another medication junkie enters the economic food chain.

I believe that if someone is self aware enough to seek out help with overwhelming emotions, that person also has the wherewithal to get through a rough patch without taking psychiatric drugs. People did it for centuries before Valium and Prozac were invented. We have the ability to help each other. Sharing a glass of wine with a friend after fighting the good fight all day is vastly different from being a boozer or drug abuser seeking elation. Shared experiences create community, which is more important to our well-being than any pill taken in isolation could ever be. Those who would abuse such things also have an addiction problem or more dangerous disorder, which is an entirely different medical matter. Deep, crippling  problems need professional help, just as an extreme physical crisis needs the equipment and skills of an ER.

A crutch is a crutch. A prescription doesn’t make a drug less of a crutch, it just gives the potential abuser a more socially acceptable excuse to keep taking it. Haven’t we learned anything by now from the opioid epidemic?