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Many people think I am anti-medication. In some ways, I am—and in many others, absolutely not. It’s a tricky balance – one that takes into account wanting to feel better quickly, but one that also takes into account the risk and cost of medications and even the risk that comes with feeling too good, too fast. Here’s how I see it:
Here’s where I am “against medication”:
A lot of us are unwilling to “do the work” that is required to not need medication: we won’t lose weight to manage diabetes, arthritis, or heart disease because it’s easier to take a pill. Even though the medications for each of these seemingly benign conditions carry effects no one wants, and some can have fatal consequences, it’s easier to take medications than, say, get up off the couch and walk. Stop eating processed foods. Start drinking more water and going to bed earlier. We’re, ahem, lazy. Yes, that bothers me. And similar is true of medications prescribed to treat people diagnosed with mental illness. It may be much easier to believe the promise of a pill than it is to do the hard work that would allow you (and me…) to act like other people act without medication.
Some of us have such idiosyncratic reactions to medications that our options are much more limited. We are required, by our hypersensitivities, to do things differently rather than medicating away our troubles. Our bodies cannot tolerate many medications. The effects are much worse than the benefits. For us, many medications—for many things—don’t seem to be an option. We are required by our bodies to work: to exercise, change foods, walk more. This bothers me, too, even though being forced into hard work by the inability to take medication is probably healthier in the long run.
Here’s where I am “for” medication:
Am I against feeling better quickly? Are you kidding me? Seriously? The answer is a flat NO. I am all for feeling better—and quickly—because I know that when I feel better, I act better. So does everyone else. I don’t think anyone—anyone—wakes up thinking, “Wow! I’d really like to try Zyprexa, or Seroquel, or lithium—yeah—and stay on it for twenty or forty years or maybe the rest of my life.”
“Feeling better” and “quickly” are the key phrases.
I believe in neuroplasticity (the brain’s ability to rewire itself to adapt to its surroundings), and I believe in similar behavioral plasticity due to epigenetic changes to DNA and RNA that occur as a result of historic trauma and other environmental influences, something about which we are just now learning. For example, the Episcopal Church’s 1928 Book of Common Prayer writes about “the sins of the father visited upon the children” and epigenetics may be a mechanism to make it happen – how you were parented, what you experienced, how you took care of or neglected your body, and even how your parents cared for their bodies and brains before you were born all make epigenetic changes to the very makeup of how your DNA is expressed. (For another example, do your own research and check out the recent discoveries about the impact of trauma showing up in the short tail of the RNA of a man’s sperm.)
However, these epigenetic changes don’t have to be expressed – your experience needn’t define your RNA, which needn’t define who you are. Just as RNA was changed in our example by a father’s experience, it can be changed by a child’s experience. The two million connections a child’s brain makes every single day in the first five years of life organize themselves according to the child’s experiences. Those patterns are flexible—more so in childhood, still at least a bit so ‘till death. “Feeling better” is a combination of neurochemicals, structural changes in the brain and change in behavior…which, of course, are then turned around and written into the brain.
How do we change these experiences that then become our brain’s new normal, which then in turn influences our future experiences? Well, medication can—and for many—does help, especially when it’s a medication that works without being dulling or causing more toxic side effects. Creating this careful ecosystem of medication takes wise, careful, judicious work—often not the specialty of crowded, underfunded, overworked prescribers who would like to do more, be better, offer more effective help.
The word “Quickly”, the other key phrase, is just as critical as “feeling better”. For people who are depressed in a big way, sometimes the trajectory of “feeling better” isn’t fast enough and trapped in this limbo of slow change, they feel well enough only to do what their depression has been begging them to do—namely, commit suicide. On the other hand, if you feel too better too quickly, the “mania” as it’s called can be dangerous. Medication can help people “feel better” “quickly” and if they can tolerate feeling better, that’s a good thing. But this immediate sea change in function can be hard to handle – even change for the better if it’s too extreme too quickly can be a dangerous magic.
So am I “against medication” or am I “for” medication? I am for conscious and careful medication that helps more of the people about whom I care live better lives, longer, with fewer effects that cause catastrophic health and life consequences. I am also for increasing functioning, a combination of learning and if needed a little chemical help. I am against overmedications of chemical soups that people on limited incomes can’t afford to take or not to take – soups that can have unintended and heartbreaking effects if not carefully managed.
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