"What if I’m on it forever?” is perhaps the most common concern I hear from clients when I recommend they talk to their doctor about the possibility of medication. As someone who’s been on anxiety and depression medication myself for decades, I find this to be a surprising reaction. If we reflect on it for a moment, it becomes apparent that it often comes from a place of shame and unhealthy fear.
To help clients see this, I propose a thought experiment: Imagine you go in for a physical and doctor tells you that you have a debilitating, chronic heart disease. You will have to live with it for the rest of your life, and while it may not be fatal, it will significantly impact the quality of your life if left untreated. You reflect on the ominous future such a condition portends.
But then the doctor delivers wonderful news: Modern medicine offers an inexpensive and widely available pill you can take every day, and by taking this pill there’s a high probability the symptoms of your condition will be diminished or even eliminated.
I would suspect that most people would be delighted to know such a treatment exists. Upon learning of this miracle of modern medicine, it would be more fitting to drop to one’s knees in gratitude for the scientific advancements of humanity than to reply with a dejected, “What if I’m on it forever?” This is the part that doesn’t make sense to me. And I try to show the client my perspective.
There is an intervention in therapy known as the “downward arrow technique” in which, simply put, the therapist starts with a client’s automatic, reactive thought to a situation and keeps asking something to the effect of, “Why would that matter?” The therapist continues this technique with each successive response from the client until the bedrock, a core belief, is uncovered (see, for example, McNally, 2023).
When a client expresses concern about being on medication forever and I essentially ask a polite version of “So what?”, a typical reply might be something like, “Well, what if I need it to function?” I reply again, “So what?” Now the client says, “That means I can’t make myself feel better on my own.” The process goes on until the client hits the core fear: “What if I discover I am fundamentally flawed?”.
The irrationality of this thought is self-evident. To continue with the earlier analogy, it’s not logical for one to avoid getting a cardiac checkup thinking, “What if I discover that I have a heart condition?” Evaluating whether such a condition already exists is actually the point of the exam, and avoiding the exam doesn’t nullify the condition. Likewise, if someone’s symptoms are so severe that they are beyond the power of psychotherapy to appropriately address, that reality exists independent of whether the person acknowledges it or not. A medical evaluation reveals the state of what already is; finding that information out does not make it so.
One way this irrational belief manifests itself is that even very scientifically-minded clients can react to the idea of psychiatric medications using the same arguments as anti-vaxxers. These are clients such as engineers and others who would bristle at vaccine misinformation. But they echo many of the same sentiments. “I don’t want to mess with my brain/body”; “We don’t know the long-term implications”; “I have a cousin who had a bad experience…”, etc., etc. I have written about these parallels before (Young, 2021).
I am not claiming that all concerns about medication use are unwarranted. Nor am I claiming that medication is right for everyone or that I can make that call. Only a person’s medical doctor can provide such a determination. But to focus on such angles in a counter-argument here would be to miss the point. In my experience, most people who have this visceral reaction to discussing medication are not coming from a place of dispassionate, data-driven inquiry. They are coming from a place of hurt, shame, and fear. The objective cost/benefit analysis can only be undertaken after they have confronted and dealt with this discomfort.
Personally, I hope I am on my medication forever. That would be great. It has afforded me great benefits over the years and I’d hate to think where I would be without them.
References
McNally, M. (2023, November 22). Overcoming self-limiting beliefs. Psychology Today. https://www.psychologytoday.com/intl/blog/empower-your-mind/202311/over…
Young, G. (2021, August 19). Vaccine hesitancy exposes flaws in the educational system. Psychology Today. https://www.psychologytoday.com/us/blog/shrink-mindset/202108/vaccine-h…
Meds Forever? Sign Me Up!
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07.05.2024
"What if I’m on it forever?” is perhaps the most common concern I hear from clients when I recommend they talk to their doctor about the possibility of medication. As someone who’s been on anxiety and depression medication myself for decades, I find this to be a surprising reaction. If we reflect on it for a moment, it becomes apparent that it often comes from a place of shame and unhealthy fear.
To help clients see this, I propose a thought experiment: Imagine you go in for a physical and doctor tells you that you have a debilitating, chronic heart disease. You will have to live with it for the rest of your life, and while it may not be fatal, it will significantly impact the quality of your life if left untreated. You reflect on the ominous future such a condition portends.
But then the doctor delivers wonderful news: Modern medicine offers an inexpensive and widely available pill you can take every day, and by taking this pill there’s a high probability the symptoms of your condition will be diminished or even eliminated.
I would suspect that most people would be delighted to know such a treatment exists. Upon learning of........
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