As someone who’s had more than her fair share of engagement with mental health services – my brother has schizophrenia, while I first spent time as a psychiatric in-patient at the age of 12 – perhaps I ought to be delighted. We’re all in this together, aren’t we? It is easier to mention mental health conditions than it used to be, and for that I’m grateful. Nonetheless, as the drive to increase awareness gathers apace, there are certain questions I feel it’s becoming more difficult to ask.
Superficially, outsiders are more understanding and empathetic. I feel I can use the term “paranoid schizophrenia” without the person I’m talking to picturing my brother as an axe murderer. There are, moreover, fewer outsiders than before. More and more people are talking openly about their own diagnoses. One has the sense of being in a club.
Yet within that club, I’m starting to fear I may have broken the house rules.
Earlier this year, with the support of my GP and a therapist, I decided to reduce and finally stop taking the antidepressants I’ve been on for the past 22 years. I’ve never felt ashamed of taking them; I did, however, feel weirdly ashamed of stopping.
The misgivings that led me to make this decision have the flavour of a political betrayal. I have always been on Team SSRI (as a common medication is known), defending them in these pages, and facing off those who would suggest depression is merely “being sad”.
It has come to feel part and parcel of being on the left. Not for me is the “pull yourself together and do some exercise” callousness of the right. I fully accept the validity of mental disorders, so why should I question the use of drugs?
“The Daily Mail is obsessed with stigmatising antidepressants” claims Vice. Well, I’m not a Daily Mail person, so far be it from me to join in. When Johann Hari’s Lost Connections was published earlier this year, with his suggestion that pills may not be the answer to depression and anxiety, I immediately felt I should join in the chorus of denunciations (even as I was in the midst of my own personal change of heart).
I started taking SSRIS in the spring of 1996, one year after I’d dropped out of university to face another hospital admission for anorexia. Having returned to college, I found myself struggling with a heavy workload, isolation and a body I didn’t feel was my own. Antidepressants were supposed to be a temporary fix, then somehow I never found the right time to stop.
Over the years, taking medication subtly reinforced a view of myself that I was not quite right. This is not the same as stigma. If anything, I embraced my “not-quite-rightness”, as offering the most straightforward, non-judgmental explanation of all that had gone before. Anorexia was no longer a mystery. Pain, fear and abuse were no longer mysteries. Instead everything could coalesce around a tangible, inevitable, apolitical not-quite-rightness, the authenticity of which was demonstrated to me each time I popped a green-and-white pill.
Antidepressants work, or rather, they have a measurable effect. Taking them might also come with a cost, but that is not an easy subject to raise, at least in the mental health circles I frequent. If you manage not to sound like some heartless sod who thinks bringing back national service would solve the problem, then you come across as a tinfoil hat-wearing, Big Pharma-fearing conspiracy theorist. For people like my brother, with more severe conditions, reluctance to take medication can be cast as evidence of “lack of insight or awareness of [his] own illness” or outright “denial of illness”. While this can sometimes be the case, the reduced credibility that comes with a mental health diagnosis puts the patient in a double bind; expressing doubts about your medication only demonstrates to others how much you need it.
The social history of mental health treatment is a long list of “things we did in the past that were totally barbaric, followed by sensible, evidence-based things we do now”. We recognise the way in which class, gender and racial hierarchies influenced diagnoses and treatments in the 1950s, but we back away from similar criticism now. Like each generation before us, we believe we’ve got it sussed, or at least that the experts have, so we can put our trust in them (after all, wouldn’t not trusting the experts mark you out as a bit, well, paranoid?).
For my brother, the cumulative side-effects of a cocktail of drugs have meant a dramatic reduction in mobility and cognitive function. His life expectancy is significantly reduced, and in early 2016 he almost died as a result of two decades on a strong anti-psychotic drug he can no longer take. I am not going to suggest for a moment that he would be better off without medication. I do, however, feel in the dark about who is making the cost/benefit decisions, and that a kind of uncritical cheerleading for mental health medication, reducing all misgivings to anti-drug prejudice or a refusal to validate mental health diagnoses, does not serve him well.
As for me, I cannot say whether there might be a time when I start taking antidepressants again. Certainly if I feel that I need to, I will. In the meantime, I find myself with far more questions than answers about the past 22 years.
A million and one things which I now realise were not down to me simply being “wrong” keep popping into my head. There are battles I set to one side which perhaps, with hindsight, I should have fought. But somehow, messily, both with the pills and without them, I’ve reached a place from which I feel safe not just to talk, but to voice my concerns and doubts. There’s nothing wrong with awareness, but let’s remain aware of all that we don’t yet know.
This is the author’s personal experience. For information about mental health treatment, ask your doctor. If you need someone to speak to, contact the Samaritans on 116 123.