According to the National Institute of Mental Health, 44.7 million adults in the U.S. currently live with mental illness, 19.2 million of whom are receiving treatment in the form of counseling and prescription medication. Still, in casual conversation, the mentally ill are often derided. Phrases like “what are you, off your meds?” and “stop acting crazy” serve as reminders that mentally ill people are considered lesser beings. Such attitudes manifest in wider harms. About one in every five people experiencing homelessness is also living with a mental illness. People living with mental illness are 16 times more likely to be killed by police and 10 times more likely to be a victim of violence than the rest of the population. Meanwhile, 37 percent of Americans living with mental illnesses are receiving no treatment at all, with that number rising to about 50 percent for people with severe disorders.
Psychiatric medication remains a heavily stigmatized area of treatment. Legitimate concerns about side effects, potential for addiction, and pharmaceutical industry abuses can be easily conflated with the deeply ingrained view of medication as a crutch. “Have you ever tried yoga?” my new primary care physician asked me when I requested the anti-depressant medication I’ve relied on to function for 14 years. His message was clear: You shouldn’t have to need this. If only you tried harder, you could be well.
People living with mental illness are not any one thing. We are in crisis, in recovery, doing better and not so good, taking it day by day. But all of us live with the stigma against mental illness and its treatment. And though medication is neither for everyone nor, for most, a one and done cure, there are far too few spaces for people who rely on medication to be open about their experiences. The following are personal reflections on mental health, medication, and stigma in the lives of four writers living with mental illness. They speak of rejection, resilience, self-examination and, above all, survival, together offering a small reassurance to those who can relate. Here’s to making efforts to get better a little less lonely. — Ann-Derrick Gaillot
Displacing
internalized shame
By Anthony James Williams
I was publicly discussing my desire to leave this world well before I received any formal diagnosis of chronic depression and anxiety. About seven years ago, I began writing long Facebook posts and blunt tweets instead of seeking the help I needed. Ironically, venting online reduced the self-consciousness that accompanied telling my best friend or partner what I was going through in person. The public nature of my confessions made me feel like less of a burden.
The millions of us worldwide who live with depression are not burdens, but we convince ourselves otherwise. I’m open about how I struggle to function on a daily basis, but I also judge myself more than anyone in my life. I was a 26-year-old undergraduate who could barely manage to eat or shower once a day. I eventually admitted to myself that I was not well. But I did not know anyone black who was on medication for their mental health, and asking for any form of assistance made me feel weak. I could not understand why every single simple task or social engagement felt like a draining obligation.
When I first started taking medication in 2016, I felt like a failure. I begrudgingly asked for a referral from my therapist to a psychiatrist who could prescribe antidepressants. But I went from feeling emotionally protected by my black therapist to rattled by my white psychiatrist. My newness to the process made me feel like a conspiracy theorist who had binged too many documentaries about Big Pharma. She slurred her words as she asked me rather dryly, “What brought you here?”
She prescribed me an antidepressant. We began with 10 mg; each day I washed down both the pill and my misplaced embarrassment with a swig of water. After taking several months to work up to a higher dosage, I finally noticed a shift. I stopped ignoring phone calls from loved ones, I skipped fewer classes, and I was closer to feeling content. Psychiatric medication was not the panacea to my overwhelming blanket of sadness, but I could move again.
I’m still on medication now and I frequently question how I take it to be “productive,” to get shit done. I get uneasy when I think about the long-term effects of the chemicals I am putting into my body. Yet I know from past experience that when I stop taking medication I cannot function. I have consistent lows that make me wonder if the pills really make a difference. However, I am lucky to receive daily texts and hugs from loved ones and bi-weekly clinical guidance of my therapist while I learn to work through my own shame. I spend much of my time telling people they aren’t broken online and in person; now I just have to figure out how to believe it for myself.
Medicating in public
By Diamond Sharp
I’m not the best at taking medication. I don’t always remember to or feel like taking it. But I need to take my meds — a mood stabilizer that helps me stay centered, ADHD medication that helps me focus, and anti-anxiety meds as needed — on a regular schedule, which means I take it during the day wherever I end up. You name a public space and I have most likely popped a pill there. I used to experience a twinge of anxiety about adhering to my medication schedule in public. As the years have gone by, I no longer worry about the optics.
When I first got my diagnosis, my medication was all out of whack. Originally, I was misdiagnosed with clinical depression and given an antidepressant that I took mainly at night. After nearly a year, I was given the correct diagnosis of bipolar II disorder and switched to the appropriate medications. My first prescription was for lithium, which I had a visceral reaction to. It upset my stomach and messed with my balance, making me stumble and worry about falling, and generally ruined a month of my life. After doing some research and speaking to another doctor, I was prescribed a different mood stabilizer and I haven’t looked back.
I take my medication after eating a heavy meal, generally around midday, which meant that for the years that I worked as an editor and attended graduate school, I had to take my meds in the office, or a subway car, or in class. It’s awkward to bust out a pill bottle in the middle of a small office or classroom, but it would be more awkward to have a bipolar episode at work, on the train, or in class. My medication helps me function every day and I am not ashamed of taking it anywhere, at any time.
CBD Stigma
By Imade Nibokun
I don’t want to get high; I just want to not kill myself. That is essentially what I told my mom in February, a week after I was hospitalized for my second suicide attempt. I’m 30, but my mom’s opinion is important to me. And there was a possibility I would be living under her roof again if I didn’t recover.
CBD oil, lesser known as cannabidiol, can be extracted from marijuana or hemp. When made from the latter, CBD oil has such a low concentration of THC that there is virtually no chance to get high. I thought this was the only version of CBD oil that could win my mom’s approval.
Once I established this, I mentioned the medicinal properties, how on TV, I saw a veteran with PTSD get his life back. Proponents of CBD oil claim that the substance can help regulate the endocannabinoid system which affects the body’s mood, motor control, and pain, among many other functions.
My mom barely said anything in response to my explanation. That CBD oil can be an extract of marijuana was enough for her disapproval.
This shouldn’t have been a surprise. My mom raised me in the Church of God In Christ (COGIC), a Pentecostal denomination known more for its output of musicians like Kelly Price and The Clark Sisters than its open-mindedness.
My first introduction to the concept of marijuana was hearing about nickel bags when I played basketball with the older guys in the neighborhood. As a sheltered church kid, I equated smoking weed with paranoia and dread that an angry God will catch you in the act and punish you.
The song “When My Words R Few” by B.Slade, who went by the alias Tonéx at the time as a genre-defying gospel artist, left a lasting impression on me.
(Since I couldn’t listen to secular music as a child, Tonéx was like my Michael Jackson, Stevie Wonder, and Prince all in one. I saved some of my lunch money for several months to buy “OakPark 92105,” a $30 album that was released in 2003, when I was around 15.)
The song opens with an intro that suggests the narrator is smoking weed on the beach.
“In my head, in the clouds, is that him?” B.Slade sings while someone in the background yells, “That’s Jesus dude! For real!” Later, B.Slade shares his guilt that is possibly influenced by his conservative Apostolic upbringing. “I know God is calling me. I’m not where I’m supposed to be. Sitting here smoking trees when I should be on my knees.”
I saw smoking marijuana as antithetical to the good Christian I’m supposed to be. Everyone from ministers to my mom told me that using marijuana is a distraction from the more serious issues of life. Years later, I learned that marijuana can be the difference between life and death.
As soon as I returned to my apartment from the hospital, I knew I had to break my cycle of suicide attempts by flushing the rest of my prescription antidepressants down the toilet.
They can kill me. I often go through a honeymoon phase with prescriptions that are supposed to give me a chance to live before all I can think about is overdosing on them. I was so traumatized by my recent suicide attempt that I was afraid to keep even pain medicine in the house.
When I told my psychiatrist about my fears, he prescribed a week-long order of a different antidepressant at a dosage too low to overdose on. At this point, I was tired of feeling like a guinea pig, dealing with weight gain, severe nausea, and more bathroom fiascos than I would like to count. I didn’t feel ready to start smoking weed, but I did feel ready to explore the potential healing powers of marijuana extracts.
Desperation redefined my world view. My mind became open when I heard chronic illness sufferers talk about CBD oil. I decided to deal with my religious guilt and be alive, rather than follow Christian dogma and be dead.
I quickly realized there’s still a guinea pig process in figuring out which CBD brand works best with your body. Some brands use different carrier oils that can produce side effects.
Fortunately, I did notice almost immediate benefits with CBD. While antidepressants and mood stabilizers can take a month or more to evaluate, I felt calm minutes after taking CBD oil. This happened whether I was using a dropper or spraying CBD oil under my tongue and swallowing after 30 seconds. This calming effect felt like someone turned the volume down on the suicidal thoughts that break into my consciousness every day, making places like a subway platform or a bridge areas where my mind would scream. Though CBD oil hasn’t fully removed the sadness of depression, the broken record-like recording of suicidal thoughts doesn’t threaten my existence like it once has.
And my mom knows this now. She saw me sliding into depression recently and asked if I was taking CBD oil. I told her no, since the gap in between jobs forced me to limit my spending. My mom gave me her credit card in response. In that moment, I could finally see that she loved me more than her religion.
No matter how ingrained stigma can be in my view of marijuana, I am capable of identifying new solutions rooted in what I need in the moment. Church kids can change. B.Slade smokes weed with no remorse now. I might too.
Treating C-PTSD
By Jes Skolnik
Sometime in 2001, I had the worst depressive episode of my life. I lay down in the tub with all my clothes on and could not get back up for a very long time. My body would not cooperate. I couldn’t even cry. I was hungry, but I couldn’t move. I had to pee, but I couldn’t get up. My roommate was away for the weekend, and I’d broken up with the person I was seeing, so there was nobody to check on me. How long will this last? I thought. Will I ever be able to move my limbs again? Eventually, I started thinking: If I move one muscle at a time, maybe I can do this. I started with my fingertips. Lift one, slowly. Now the next. Now the next. Now the whole hand. After an excruciatingly long time, I wobbled down the hall to the kitchen phone and I called my parents. “Help,” I said. “I need help.”
I’ve always had self-destructive impulses, but they’ve always been balanced with a strange and bullish desire to live that appears only when I hit the absolute bottom. I’d been thinking about killing myself since I was a little kid. A couple of times I got close, but I always thought about the people who loved me, my parents in particular. It would have wrecked them, and I couldn’t.
A survivor of childhood sexual abuse and assault, I’d also always been a sad, interior, tentative kid. I’d been to therapists, with varying degrees of luck; the first two, I decided, weren’t trustworthy. They diagnosed me with major depression, threw medication at me, and hoped it’d work. But I opened up to the third. She asked me the right questions, and she diagnosed me with post-traumatic stress disorder, major depression, and anxiety. She and my following therapist, who had read Judith Herman’s Trauma and Recovery and who introduced me to the concept of C-PTSD, would do courses of cognitive-behavioral therapy (CBT) and eye movement desensitization and reprocessing (EMDR): two routes to the same place.
The therapy helped, but as I healed and got stronger, deeper and deeper wounds — things I’d been afraid to touch before — opened up. The therapists I’d been working with were leery about prescribing me medication. But because of that depressive episode that led to my hours in that tub, I knew I needed it. I was prescribed medication I will not name because it’s nobody’s business and I’m not shilling for it (it is an anti-depressant and anti-anxiety drug), and I’ve been on it ever since.
It worked for me, is the thing. It still does. I had energy I hadn’t before, and I started moving forward in therapy. I thought about killing myself less often; over the years, the gaps between suicidal periods got longer and longer, and the periods themselves shorter and shorter. A fog that had been present my entire life had lifted, enabling me to see my way out of the pit and begin climbing.
Someone I dated briefly once told me quite self-righteously that my medications were a “crutch,” intimating that I had weakness of will, that I could throw off those appliances and HEAL MYSELF if I really wanted to. This kind of evangelical thinking is deeply dangerous and also does so many of us a deep disservice; it is with strength of spirit and will that we are able to push through, to live, to ask for help when we need it.
I hear constantly from various sources — people in my life, the current discourse of wellness, media outlets of various sorts — that psychiatric medication, if used at all, should be a temporary thing for everyone, that the goal should be to Get Well And Get Off Of It. Indeed, this is how many people use it, or would like to; the addictive properties of many anti-depressants are no small issue. But there are some of us, like me, who have chronic mental illnesses, and who need medication as part of our changing treatment plans (mine includes, at the moment, trauma-informed talk therapy and meditation as well). Perhaps, someday, I will not need it, though there is significant research out there about the impact of childhood abuse and assault on brain development; I have had brain scans that show similar results. Perhaps I will be on medication my entire life.
I’ve been glad to see more therapists embracing a holistic approach, treating the whole person, body and mind, in their particular contexts and with an understanding of their needs, abilities, and resources. We have this sense that our selves are separate from our bodies, that we are not part of interconnected systems and environments, but over and over that proves to be untrue. Only by recognizing this can we get the kind of care that enables us to function at our best.
