Will Hall on psychotropic drug use

I had written a post on psychotropic drug use last year. At that time  I got a brilliant, developed and well thought out response from Will Hall in the comment section which I’d like to share here again.

I am in graduate school studying psychology and a while back we had a class on the DSM and related topics. More than one student kept asking “When does someone need to be on meds?” “When should someone be medicated?” and “When is it necessary to medicate someone?”

I of course offered a lot of information and the students learned a lot, but something about the questions keeps bothering me. Not the lack of accurate information surrounding medications, but something more basic. This is somewhat hard to explain but I’ll give it a try:

It’s as if a certain way of thinking about the problem is behind the way the question is formulated. “Are medications necessary?” is for me not as meaningful a question as “Are medications useful? Are they helping you? How do you experience them? What options do you have? How did you come to the decision to take medications? How informed are you?”

In asking “When are medications necessary?” there is somewhere a God figure who Knows What’s Best. This figure has always been behind medical authority. It also never really exists.

You can never know if medications “are necessary” because you can never time travel into the past or future. It is not a meaningful way to frame the question, because you are asking to know the Truth about the past or future. Nothing is ever “necessary.” All you can say is “So and so said they were necessary” or “So and so believes they are necessary” or “they feel necessary to me.”

Think about any choice you make in your life, any choice. “I need to go to work.” “I need to take care of my children.” These are choices we make that people would support, and make sense, choices we make every day. But are these choices “necessary?” We feel they are, but we can never really know if they are from the God’s Truth, time travel point of view. Maybe a different choice would be better?

Say someone for example quits their job suddenly and plunges into poverty, completely overturns their stable life. Sounds like a disaster, but many people have in fact done this and come out much better off. Maybe they get a better job and a better life.

Same thing with taking care of your children. Some parents may hand over childcare to a grandparent or a spouse and it ends up being much better for them and the child. People do terrible things to children because they feel it’s “necessary.”

The reality is that we give doctors a power to “know what we need” when in fact, does anyone ever really “know what we need” in a final sense? All we have is our experience. “I took a Klonopin last night and today I was able to go to work because I got some sleep.” That feels sound, it feels useful to you, it feels positive. So you decide it was the right choice. Great, I totally support that. But the nature of being human is that we can never know if any choice was Right in an objective, final sense, because, unlike God, we can’t time travel and see the implications of taking different choices.

I can look at your Klonopin taking and see you are strung out during the day, not getting good sleep, and have anxiety that is probably a result of taking the Klonopin, realize that you are going to have a hard time getting off, and see that your physical health is declining from taking it. I can tell you all these things. If you say “I don’t believe you, I need my Klonopin,” can I really be so sure I have the answer when the person doesn’t? Maybe they are in denial and stuck for a reason — maybe they are protecting themselves from some demon of trauma, some memory, some family situation, and the time just isn’t right to deal with it, and if they did push and got off Klonopin they would end up in a crisis and worse off than when they were taking it. Can I time travel to alternate realities and know what’s best?

I realize this sounds like a radical point of view, but I don’t think you can get around it. You never really know for any choice for certain if it was “necessary.” No choice is “necessary,” we can agree it is necessary because it feels like the best thing, but we can’t ever know all those alternative realities or time travel to see what different options would lead to. All you know is you made the choice (or it was made for you) in specific circumstances, you try to do the best you can, and you look at the consequences and decide whether something is right for you. “Whatever works for you” is a mantra I’ve repeated over and over again in my work. “Should I take medications?” “Whatever works for you.”

This comes up around suicide, another place where doctors like to play God. People have told me, “Will, this group you started saved my life.” I appreciate the compliment and value the way the person feels helped, but I see this statement as predicting the future. What if they never found the group? Can they time travel and know that some other way of getting help would never be found? Maybe they find a better group, maybe they learn to help themselves after spending more time alone? Saying something or someone “saved me from suicide” is in a sense to predict the future or claim to know an alternate reality. Even someone who is talked back from a ledge or found and rushed to the hospital – all you can say is “almost certainly” or “extremely unlikely” that they would have survived. Maybe somebody else would have been there to help them. Maybe they have a freak physical reaction to the overdose they took. Maybe there is a miracle (they do happen). Life is fundamentally creative and unpredictable.

That goes for medications too. No one really knows. I am absolutely not saying that because you can’t predict the future, people shouldn’t know that drugs are toxic or addictive or they have specific results. They should know. Some consequences are so completely predictable that they might as well be certain. But very strange things are possible. Remember that science used to believe we don’t grow new brain cells, that the brain can’t heal. Now that is known to be false: the brain does grow new cells and the brain can heal. When a friend told me he had cancer a few years ago I supported the decision for surgery and was very worried for him. I also told him to take the information about likely outcomes and how much danger he is in very seriously, but to hold out the possibility that not even doctors know 100% what is going to happen.

This may sound like an abstract philosophical point of view, but it’s instead extremely practical. People want Answers. There are none. They want Certainty. There isn’t any. Doctors thrive on this need people seem to have to know their choices and life paths are Right and Necessary. We can never really know. All we know is that we have an experience. A choice feels right, it is useful, people around us seem to agree. So we go with it. But can we know the other choice wouldn’t have been better?

This gets into a direction I think it is very useful to explore: Doctors as priests and science as religious belief. What doctors and science deal in are very practical decisions and tools. It’s not the same as religion. But there are very strong parallels in how we turn to them as Authorities and they step in to give us Answers based on some presumed power we seem to give them to travel in time and to know alternate realities resulting from different choices. That authority is comforting. We do need certainty. But like the decline of religion over the past 150 years or so, we need a decline in blind obedience to doctors and science, and we need to put more authority in ourselves.

I feel very strongly that I needed to get off neuroleptics and get out of the mental health system. When someone comes to me and says, Do I need to get off neuroleptics and get out of the system?, I don’t respond by saying Yes. All I can do is tell them my experience — and be open to theirs. Maybe their circumstance is such that, unlike me, the alternative options are worse than the ones I faced. Maybe things will go differently for them than they did for me. There is no way for anyone to predict the future.

If you read the Harm Reduction Guide to Coming Off Psychiatric Drugs that I wrote, you will see that this subjective perspective informs the approach throughout. I think it is part of Harm Reduction philosophy — only you can know your life. It deeply honors the uniqueness of each person’s experience and validates the importance of discovering for yourself without anyone else giving you final authority over the right and wrong of your experience. This is for extremely practical reasons. We just don’t know. The experiences of people taking meds are all over the map, from I’m Saved to They Ruined My Life.

If we validate the individual, put the power back in personal experience, and open up to experimenting with the unknown (based on as much information we can about other people’s experience and what the science does and does not know), we offer something that can in my mind truly help people: a sense of control of their own lives.

First published April 2009

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