Sharing my journey through the mental health system, and especially my successful withdrawal from psychiatric medications, seems to have struck a chord with readers. Many have left comments stating their own desire to break free of pharmaceuticals. A few visitors have expressed reservations about my stance on these issues, because they have found psychiatric drugs helpful and life-enhancing.
The two positions (a belief in the value of medications and a desire to break free of them) are not mutually exclusive. There is no reason a person couldn’t credit drugs with saving his or her life, and still hope to someday be liberated from taking them. But there is obviously a tension between faith in pharmaceuticals and the desire to live without drugs.
The following text was cobbled together from my replies to the desires and concerns of readers. It explains at some length the fallacy in believing pharmaceuticals to be potent weapons against mental chaos. The next post will argue against long-term use of medications without trials of drug reduction, and also offer some suggestions for tapering off pharmaceuticals.
It is undeniable that people seem to get better on drugs. However, although there can be little doubt that the active agents in medications are sometimes responsible for the observed improvement, the placebo response and other factors need to be kept in mind. Pharmaceuticals are seldom prescribed in isolation. When someone presents to a psychiatrist for care and gets better after receiving a drug prescription, it is hard to dissect out how much of the recovery comes from the active agent in the pill, versus the support, encouragement, and therapy that go along with participation at a mental health clinic. Many people who get better on medication are recovering because of their mind’s own hidden powers, elicited in the context of a supportive environment, and not because of the pharmaceutical chemical.
One commentator pointed out that patients may try several medications without success, and then finally be given the ‘right’ drug combination, after which they get better. This sounds suggestive, and perhaps in these cases the pills are making a big difference. But in every real-world situation many other factors are at play, so it’s also possible that the supposed ‘ideal’ drug cocktail is merely a coincidence: it happens to be chosen around the time when improvement would have happened anyway. Only controlled, randomized research could settle this question definitively.
When placebo-controlled research is performed that adjusts for the myriad other variables in treatment, drugs never appear particularly decisive in their effect. In a typical ‘successful’ study, 60% of those who take a medication show some level of improvement, whereas 40% of those on placebo recover just as much. By these numbers, only one person in five who gets better on a psychiatric drug is doing so because of the chemical agent in the pill. Four out of five are improving for other reasons.
And of course the published research has been heavily biased to demonstrate efficacy. When all of the suppressed, failed studies are added to the analysis, the active agents in drugs look even less helpful. On the basis of careful review of both published and buried research, Psychologist Irving Kirsch has concluded that antidepressants depend almost entirely on placebo action for their effectiveness.
The tendency of the mind to respond to suggestion can hardly be overstated. Although the word ‘placebo’ carries a connotation of ‘fake,’ it really should awaken us to the healing power of expectation. In a future post I’ll explore placebo action more deeply. For now, I just want to highlight that medications may help us feel better for reasons other than the neurological effect of the synthetic chemical.
Having expressed some reasons for doubting the widespread perception that these drugs have nearly miraculous powers, I must emphasize that medications may be useful in the short run in many cases. Possibly they are also necessary on a more chronic basis at times. But given that research evidence supporting their value is weak, whereas their ability to cause serious side effects is undeniable, drugs should not be looked at as the most important, reliable, or safest tools available to aid those suffering psychic distress.