Introduction: Stigma

In the course of therapy, sometimes we reach a point in which one’s mental and emotional struggles are so overwhelming that it’s time, or past time, to consider the option of taking psychiatric medication. When I was growing up, psychiatric medication experienced a sort of revolution with the popularization of antidepressants such as Prozac and treatments for ADHD such as Ritalin. As is often the case when new technology and medication bursts onto the scene, some people run toward it with great enthusiasm, while others wring their hands in fear over what it will do to us as a species.

When I was a depressed teenager considering medication, I listened to those arguments and my older Internet friends who passed their concerns along to me, and it made me resistant to trying. The fears they expressed, which I sat with, were that psychiatric drugs would strip us of our individuality or turn us into numb little sheep incapable of producing anything creative, beautiful, original, or courageous. Other concerns were that treating depression with medication put the blame solely internally—that it was me and my bad attitude that was the problem, not my circumstances.

Fortunately, psychiatric medication has increasingly lost its stigma over the years and become more normalized, but these fears and concerns persist, and they often show up when people deep in their emotional suffering are invited to explore taking medication as an option.

Before I go further, I want to clarify that I am a Master’s-level mental health clinician with no training in prescribing medications to care for mental and emotional distress. Thus I am not able to advise you on whether you should take medications or what to take. I can provide certain factual data supported by scientific evidence. And I can support you in how you think about and decide whether to take medication.

As I’ve gone through my own journeys as a person and a therapist, I continue to think there are legitimate questions and skepticism around the psychiatric model of care, and at the same time there are very clear merits to treatment that should not be dismissed outright. When one is deep in emotional turmoil, stuck for a long time, there is no shame in taking medication as a part of one’s treatment plan. Psychotherapy is about learning to swim in the waters of the soul, but if you’re drowning, that is not the time to learn how to swim. The priority is to stop drowning.

Yet concerns persist for those considering it: Am I becoming dependent on a bunch of chemicals? Will I lose what makes me me? Will I become numb and disconnected from reality? Am I betraying my authenticity?

Concern: Chemicals

A contradiction often unacknowledged by those concerned about becoming dependent on medication, often voiced as “chemicals,” is that they usually are already using substances to deal with their mental and emotional problems. Indeed, they’re often using drugs and alcohol, or behaviors like sex, shopping, gambling. What they’re not using are drugs prescribed by a trained physician or nurse practitioner, in an accountable and collaborative relationship.

The concern about putting chemicals in one’s body may be a gloss over more nuanced concerns, but on its face it is incomplete. We are always putting chemicals in our body. Our mood and thoughts are shaped as much by the food we eat and the water we drink as they are by whatever else we put in our bodies.

The irony is how often these unprescribed drugs reinforce and complicate problems. Alcohol is a depressant, but one frequently turned to by depressed people. Methamphetamines and opioids are chemicals that some bodies need support manufacturing, but taking them ad hoc from your friend behind the gas station is quite a different experience than taking them in a collaborative relationship with a prescribing physician who is informed about the secondary effects they may have on your body.

Within these concerns is I think a mistrust of pharmaceuticals as “manufactured” or corporate-promoted chemicals with a bias toward “natural” things as being intrinsically better for us. About this, conversations are being had. But we may also again not notice the contradictions and unexamined assumptions we make. What does “nature” really mean? What does it mean for something to be processed or synthesized? Fermentation is a natural process, but alcohol in the form we consume it is not found in the wild. Nicotine is a plant whose overconsumption can really hurt our lungs and hearts, and depending on the brand of cigarettes, it may get paired with a whole host of other chemicals.

Nature is a place of wonder and majesty, and a great deal of the natural world is fatal to humans. Our whole experience has been about navigating this ongoing tension, finding ways to make a safe place for ourselves and transform nature into what benefits us.

Concern: Authenticity

It is so strange that having mental or emotional distress often requires us to become little philosophers grappling with the big questions when all we may want is to get through the day without a panic attack. Who am I? What is authenticity? Am I my mental illness?

Increasingly the word “authenticity” feels unhelpful to me, for I experience all of us as tiny worlds of rich, diverse, and contradictory parts of self. At the same time, there is something true about it. We can feel when we are not being ourselves—when all of our relationships are based on a facade that feels exhausting to maintain. When we are hiding from everyone in our life something true about ourselves, something about which we feel shame. That shame-based hiding of parts of self is I think what authenticity points toward. It’s not that the facade is not who I am, but it is only one part of me, and every part of me wants to be loved.

I’ve noticed that this fear around losing authenticity seems particular to people suffering mood disorders such as depressive or Bipolar conditions. Very few folks experiencing intense anxiety and panic tend to identify with those parts of themselves in a protective way. Nevertheless, there is something about these mood states that do feel important, valuable, and sometimes the idea of medicating feels like abandoning those parts of us.

This is a concern worthy of holding in awareness and paying attention to while you’re trying medications. It’s not one with a simple answer, but one that can only be explored by trying and staying in relationship with your care providers. In some cases, I’ve observed people feeling like the medication helps them to be more of themselves—they start to see how their manic or depressive parts took so much oxygen that there was little space for other parts of them. In some cases, folks seem to feel they can hold their moods more effectively, but the moods do not totally go away. In some cases, people feel numb and detached and decide this is a sign the particular medication is not right for them.

Concern: Agency

Given our unique histories with authority, mental health providers and medical caregivers, we may not trust them to act in a way that’s collaborative and supporting our own health goals. We may fear that they’ll medicate us in a way that makes us numb, placated sheep, trying to kill our uniqueness and originality.

These concerns are not irrational, and your concerns and desires should be included in any relationship you have with a health provider. If you are working with a medical provider you do not trust to listen to you, take your needs seriously, and support your health goals, then you have every right to be suspicious. I hope you are able to address that with your provider or find someone who is a better fit.

It is appropriate to have some skepticism of any treatment. Assuming any kind of therapy or practice is the solution to all your problems is itself a big problem. At best, this ungrounded hope sets you up for disappointment that may lead you to give up too quickly when things get hard. At worst, the attitude makes you susceptible to snake oil peddlers and cult leaders willing to exploit your suffering for their profit and ego.

Concern: Independence

Trying psychiatric medication complicates our notions of independence in a few ways, one of which was addressed in the topic of “Agency” with regard to collaborating with medical providers versus deciding for one’s self what to do.

The other complication is, I think, rooted in a Western notion of the ego that is incomplete. We have this bias of thinking that “Who I am,” my uniqueness, is this specific quality that needs to be protected from the devouring forces of the external world. On the other side of this idea is a fear that becoming dependent on something we cannot make ourselves, like a drug, means that we’ll be helpless and easily victimized.

It’s very humbling to consider the possibility that our very experience of reality and truth may be determined by factors we cannot choose and manage alone, like our neurobiology, our diet, our environment, political realities, emotional contagion from the people around us, the historical age in which we live, our culture. If you believe in spiritual realities, you might add a whole host of other unconscious and unchosen influences.

With all that we’ve been learning about the body and the Self in the past century, it’s clear to me that the Self is ecological, a microbiome within larger biomes. We’re a meatsack with a running nervous system, but we also house all manner of bacteria in our digestive system that weren’t made from our bodies or our DNA. And if they’re not doing well, they can really affect our mood. And without them, we’re screwed.

For some, taking a psychiatric medication feels like an admission of defeat. They believe that strength and self-control means being able to dominate one’s mental and emotional states through sheer internal will. Yet I believe this to be a distortion of the nature of will. Will is more about how we do things than what we do. To decide to take a medication to offset the brain’s tendency to absorb too much serotonin, for example, is an act of will. It is making a conscious choice to utilize one’s available options toward one’s own goals, and requires consistent practice and follow-through.

Conclusion: Health

One aspect that becomes clear in these conversations is the painful way that morality gets blended with health, diminishing both. When we make the choice to use medication or not a commentary on our moral worth or virtue, we are in a bind that ironically means we care more about others’ judgments of us than our own wellbeing.

If it works for you, if it makes your life better and moves you toward your health goals, who cares? That person who is judging you for needing medication? What do they know? Do they have to live with your brain every day?

Illness is a natural state of the body, and much is beyond our control in terms of what tendencies we inherit toward physical and mental or emotional health. “Healthy” has become another word we substitute as a moralizing judgment on behavior, with rarely any clear foundation in science or grounded in the context of the individual’s actual health needs.

There is no objective criteria for “health” that is universally agreed upon, and seeking such may not be useful. What is useful is identifying your health goals, and using those to evaluate what supports and interventions move you toward them. If you are satisfied with your health, then whatever structures you set up are working for you, whether that’s eating vegan and jogging daily, or whether that’s seeing three different therapists a week and taking meds twice a day.

If your goal is to not think about suicide every day, you could try all kinds of things, including medication. There’s no one answer. For some people, certain medications increase suicidality, so that outcome would be unhelpful. Maybe it turns out taking dance classes was the better move. Maybe it turns out all you needed was Prozac for a few months. Maybe you just need a space away from oppressive assholes and be surrounded by people who love you. Maybe you need all of these things and medications.

You get to decide what your health goals are, and you deserve to work with people who will help you think through all your options and find the right choices that work for you. Unfortunately, that can be a long process of trial and error even under ideal circumstances, and just the process of putting together a good health team may be a challenge.

Whether you choose to try medication or not is your decision, but let it be your decision. Let it be an option that you consider fully.

Cynthia Wang of the Kellogg School at my alma mater, Northwestern University, has an academic interest in conspiracy thinking, and has engaged in a number of studies that have teased apart factors that influence the likelihood to conspiracy-mindedness. In a recent article, she suggests that people who feel disempowered or lacking in agency are more prone to finding conspiracies, both in the larger sense of what we think about as “conspiracy thinking” but also within their organizations. Wang’s prescription to address conspiracy mindedness is to work with the person to help them identify their goals and clear pathways to their goals, nurturing a sense of agency and personal control.

Wang’s insight adds nuance to the suggestion that conspiracy thinking is a reaction against a world that feels discordant and beyond control, a way to establish control when agency feels far away. Jessica Stillman at Inc.com suggests Wang’s approach as a way of engaging with folks who have been enfolded into the QAnon conspiracy phenomenon, to help them think about goals and concrete steps they can take in their life.

Overall, I agree that empowerment is a better move than arguing with the conspiracy itself. As we’ve learned through decades of research, once people form beliefs, those beliefs prove remarkably resilient even when they are factually disproven. Indeed there is evidence that arguing with someone’s belief using facts is more likely to reinforce that person’s belief than cause them to reflect and abandon it.

Factually countering something like a conspiracy theory is like trying to weed dandelions by cutting them off at the stem. Unless we get all the way to the root, the dandelion will simply grow back. To be truly effective, we need to look to the roots, which requires a measure of compassion.

What I find useful in such conversations is to recognize when we’ve become enmeshed in a battle for who defines reality and to pivot toward exploring the deeper motivations of the other person. The question I tend to use to do this pivot is some variation of, “(If all that you’re saying is true,) How does it affect you?” (The parenthetical comment is rarely spoken but for my own sake I remember that I am not necessarily embracing their reality.)

When pivoting in this way, we need to commit to moving toward genuine curiosity and concern. Most people, I find, intuitively sense this is a disarming move and respond with some measure of wariness. If there’s a sense that there is an agenda to use the information against them, they’re not going to open up. In a sense, this pivot is about letting go of the effort to argue about realities and to become curious about what in the other person’s life is engendering the powerlessness that has made their reality attractive.

If we can keep going, exploring where they feel powerless or stuck, we might be able to help simply by witnessing and caring about their feelings. Often this alone helps people to feel less isolated and overwhelmed, and helps them ground long enough to come up new ideas. You might ask if they’re interested in suggestions, or you might ask them more questions about where they feel stuck and if they have resources.

What Wang suggests, and I find to be true, is that when we help address the underlying powerlessness, anger, and fear, and help each other find our own power, then the need for a grand theory of our powerlessness becomes less important. We also have opportunities to create solidarity with each other, or offer other suggestions for concrete actions that build power.

Emotional Fatigue, Justice, and the Long Game

The merit of learning approaches like Wang’s is that it gives us another way to intervene when we are advocating for change and encounter people who are extremely hostile or appear to inhabit a separate sphere of reality. When we cannot follow each others’ intellectual labyrinths, we can move into the territory of the heart and will, which tend to be more relatable and accessible.

Debates about lizard people and time travel is not something I have any interest in, but I sure understand what it’s like to feel out of control and afraid about the way things are today. Instead of yelling at each other to think right or do better, we have an opportunity to help each other ground, remember what we want, and think about what paths are available to move toward that. From a public policy perspective, Wang’s insight points to the sense that much of our unrest today is rooted in a sense that our citizens do not know what is possible or how to pursue their goals.

When I suggest this work, I hear from folks who are annoyed that I am asking them to do more emotional labor, especially with people who are harming them or seem bound to ignore them. In the case of QAnon, it is apparent that popular QAnon beliefs are retreads of long-running anti-Semitic tropes. The whole story of child sacrifice, sex cults, harvesting the blood of innocents to drink for their vitalizing powers, secret cabals of wealthy people—these get dragged out in different clothes during periods of social crisis to make Jewish people the scapegoats of larger tensions

So am I asking Jewish people to be kind, thoughtful, and patient with QAnon supporters? No. I do not think anyone is obligated to coddle bigotry and scapegoating, especially not the people most impacted by it. And if someone has been striving to engage in the hard conversations and is feeling burnt out and tired of doing everyone else’s emotional work, I think it is better for the world if you focus on what restores your spirit and gives you strength and joy.

In the long run, I have always been more interested in effectiveness than what feels emotionally satisfying. And sometimes being effective looks like “losing,” letting a battle go or end, not adding that parting shot, not jumping to the attack of every bit of misinformation or every baiting comment. Sometimes being effective means learning to let go of the noise of the ideology and redirect attention to the emotional and material roots from which these beliefs have grown.

In working with misogynistic men, for example, it is not always effective to combat the misogynistic words directly. Instead, we may need to acknowledge and set aside the misogyny to seek out the unmet needs and feelings, the frustrations and the hurt. Once those deeper pains have been surfaced, we also discover the genuine urge for authentic connection, the genuine feelings of shame and guilt, and the possibility to help these men learn the skills they need to get these needs met for real.

Another critique, related to the first, is that it is easier for privileged people to engage in the work of meeting a hostile person where they’re at and helping them identify their emotional needs, which is true. I would clarify by pointing toward why privilege makes it easier—it’s easy for people not directly impacted to set aside the aggression of the attack and go to the deeper need. It’s easier for me as a non-Jewish person to be patient in conversation when I am not at existential threat from anti-Semitism. All the more reason for me to be the one to do this, when I have the resources.

I find the most persuasive conversations and movement happens when people can have honest conversations that are not polarizing, in which they feel heard and taken seriously—not necessarily their ideas, but the emotions beneath the ideas. I find these conversations really do not work in unmoderated public spaces like Facebook.

And also I find these days it seems like you only get social justice credibility when you call people out in public spaces where others can see. A long-term, supportive yet confrontational kind of relating feels unfashionable and uncomfortable because it means that there are times we might choose to preserve the relationship instead of a direct attack, or to address things in private.

For me, there are times I’ll wait until I sense the other person is open to hearing another perspective, and that could take a very long time. I do not always interrupt other people’s conversations and erode the relationship with arguments that are more likely to generate heat than light. I still make time to express my perspective in a space where I can set the frame for the conversation I want.

And in the meantime, a part of me wonders what I would do if someone called me out in a public post and demand I account for my relationship with a person they consider problematic. My way of relating invites mistrust that we are simply collaborating with people like us, and that is a risk.

Compassion is present, but compassion is not simply agreeing with everything a person says and making excuses because they’re having a hard week. What we see on the surface is not the entirety of the truth, and compassion gives us a pathway to the roots.

I don’t believe public arguments and call-outs are intrinsically wrong. They are different tactics that serve different purposes, and have value in situations where a personal connection is impossible to establish or dangerous, or the community needs protection when the subject of the call-out has proven they cannot be accountable in good faith. Without strength, kindness loses its potency. But without kindness, strength is simple cruelty.

Return to Power

In conclusion, I feel Wang’s insight is applicable to many of us right now. Across the political spectrum, I see our extreme manifestations of terror, anger, and despondency as reactions to the instability of the ground on which we stand, and feeling a lack of agency in life. Sinking into the feelings of powerlessness and overwhelm, remembering your goals, and figuring out what concrete steps you can take toward your own goals have all become more important since the election of 2016, and since the pandemic almost a daily necessity. The problems facing us seem so huge and insurmountable that it crushes us.

When we feel powerless, we are at risk of spinning out into anger, fear, and rage. We need to feel heard by someone who cares, who can then help us remember what agency we have in the world. If you can offer that to someone, that is wonderful. If you need that, think about who in your life might be able to offer that. If you cannot think of anyone, you might try the following:

Notice your relationship to the ground. Notice how the ground is supporting you right now, and see if you can start slowing your breathing down. As you inhale, notice the tension you’re carrying in your body. Notice what feelings you’re having. As you exhale, see if you can let the ground take more of that tension. See if you can sink into that which you’re sitting upon and let it hold your weight. Notice your back.

If you can, as you breathe in, imagine you can breathe into your belly center, our center of gravity and movement, a place of power in many traditions. Just breathe into your power, and let yourself be supported. Ask your body, what does it need right now? What would help?

If an answer comes, see if you can make a plan to move toward that.

If the answer seems impractical, ask yourself, how would I feel if I had this thing I need? And if you get an answer, imagine that you can breathe that feeling into your body. Imagine a time when you had that feeling, if needed, and see if you can give it room in yourself.

Think about something you want, and one concrete step you could take today that could move you toward that want. Even if that want would be impossible to accomplish today, there could be one thing you do that moves you toward it. It could be an incredibly simple, small step. Do an Internet search about it. Find a book about it. The smallest step is the best step.

If you can think of nothing else, look around your space for something you can clean, and clean it.