IF A PILL WAS developed that could restore the body after spinal injury without painful physical therapy, everyone would rejoice; well, everyone except unemployed physiotherapists. But the reaction is so very different to pills that restore the depressed mind without a need for emotionally-harrowing therapy.
Antidepressants are routinely dismissed as “Band-Aids” that merely hide the real problem, or they get smeared as being nothing more than nice little earners for “Big Pharma”. On the other hand, the talk therapists who oppose medication are portrayed as standing up for their patients, rather than as professionals protecting their own jobs and interests.
But why should those who already suffer from an illness have to suffer more to recover? Why, if medication works, shouldn’t they take a chemical shortcut to a healthier mind? Since mental health is not a struggle for most people, why do we demand extra work from those for whom it is? As a former addict who now takes antidepressants, I have long pondered this. My own story illustrates that suffering for its own sake can be counterproductive, while medication can ease pain without blocking emotional progress.
When I first snorted heroin I felt like one of the patients that the psychiatrist Peter Kramer quotes in his classic book Listening to Prozac, “better than well”. I was safe, warm, perfectly nurtured — for once, comfortable in my own skin.
The contrast with my normal state hooked me: I had done the line in a fit of pique, jealous that my boyfriend had been with another woman. I was in a crooked room in a welfare hotel, where he was selling cocaine to some heroin dealers; they offered the line to stop me shouting at him. I had also been filled with self-loathing: my cocaine habit had got me suspended from Columbia College and, at 20, I was convinced that I had ruined my life.
But now none of that bothered me: the room seemed quaint, not squalid. Sure, I was nauseated, but who cared? I felt as though I had finally found “the answer”, the missing piece that had kept me from feeling as worthwhile as anyone else. If I had naturally felt this safe and protected, I thought, I’d never have had the social problems that had led me to seek relief through drugs.
Unsurprisingly, I soon added heroin to my coke habit and began a three-year descent that left me weighing 80lb and taking both drugs up to 40 times a day. I realised that I had to stop when I found myself begging a man I despised for heroin; I knew that the next step would be exchanging sex for drugs — that, somehow, jarred me into recognising the severity of my addiction.
I entered treatment the next day, but thought that this meant I would never feel OK again, that I would have to live feeling loathsome and defective, with the constant sense that I did not deserve affection.
Fortunately, through 12-step programmes, I learnt to stop tormenting myself. Though they do not work for everyone, in meetings I discovered that, for example, when I felt excluded, that was my own, possibly flawed perception — not necessarily the truth of the situation. By behaving like someone I would want as a friend and silencing the internal debate over whether or not my behaviour was “authentic”, I gradually learnt to ease up on myself. By doing estimable actions, I gained self-esteem. This reduced my desire to escape by taking drugs.
However, these essentially cognitive techniques did not eliminate my bouts of depression, during which my self- hatred would return as furious as ever. “Twelve-steppers” insist that pain, as the founder of Alcoholics Anonymous put it, is “the touchstone of all spiritual progress”; that my depression was saying something I needed to hear.
Few would dispute the notion that painful experience can build character, just as stressing muscles by lifting weights increases strength. What the critics of antidepressants tend to overlook, however, is that too much pain is just as likely to lead to stagnation and self-destructive behaviour.
I began taking antidepressants about seven years after I kicked cocaine and heroin. Before that, both the self-help groups I attended and my individual therapist had discouraged medication. But I decided to try antidepressants when I declined into a state in which my ability to function at work was seriously threatened because I could not experience anything other than constant dread. Certainly, I thought, it was more likely to help than heroin, which was beginning to seem like a good alternative again.
Ten days after starting Zoloft I felt the first therapeutic effects. Soon, I again felt transformed, as I had in that seedy hotel, so many years before. Unlike heroin, Zoloft did not make me euphoric, but it provided a similar sense of comfort and safety. I felt like “myself again”, as another of Kramer’s patients reported. With antidepressants, I wasn’t “better than well”; I was the way I am when I’m OK.
The critics of antidepressants argue that I’m just “anaesthetising” myself. But they don’t recognise that not all pain serves a purpose — that sometimes it’s as distracting from love and work as a shrieking car alarm. Similarly, some claim that my recovery somehow isn’t “valid” if I don’t work for it — but is recovery from cancer less real or “authentic” or legitimate for those who use new, targeted drugs that have fewer side effects than brutal chemotherapy?
To be sure, I’m a big supporter of hard work to attain one’s goals, but it’s kind of difficult to get anything done if you cannot get out of bed. And I don’t think my achievements as a journalist are any less authentic because I take medication: it helps to level the playing field, as I see it. Besides, either my work is good or it isn’t — it does not matter to the reader whether I struggled over every comma or dashed it off.
Other opponents of antidepressants point to their side-effects, which can be a real problem, but the critics skate over that their preferred option of talk therapy can harm, too. Many widely used talk therapies for depression have been shown to backfire; while “recovered memory” therapy has split countless families by conjuring up false memories of abuse and “rebirthing” has killed people.
What critics also miss is the crucial role of pleasure in learning and in good behaviour. Studies find that happy people are more charitable and kind. Irritability does not make for either a good parent or a good student, worker, friend or lover.
There is no moral superiority to talk therapy: sometimes “happy pills” really are the best fix.
Maia Szalavitz is author of Help At Any Cost: How the Troubled-Teen Industry Cons Parents and Hurts Kids (2006)
