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Why
Go To Therapy
When You Can Just Pop a Pill?
Why
Ask?
by Thomas
Pope, MFT
Advances in psychotropic
medication over the past two decades have changed the course
of treatment for those suffering from acute and chronic mental
and emotional distress. Medications work better now, and at
times are lifesaving tools. Americans are using them more,
especially in the treatment of depression, anxiety, and addiction.
However, reliance on a medication can mask the underlying
issues and hinder the possibility of resolving the conflict
or stress that is contributing to the mental condition. Medications
can relieve symptoms, but not cure underlying problems. When
people feel better, they sometimes don't want to look at tough
issues or unpleasant feelings. The refrain of depression being
a chemical imbalance takes people away from a questioning
of what stress is causing the brain to become chemically deficient.
Medications are not always the miracle cure. For some, medications
don't work very well. For others, the side effects are too
debilitating. And with some medications the efficacy of the
treatment diminishes over time.
There are alternatives to medication. Some studies show that
exercise is as effective as medication in treating depression.
And most "experts" recommend that people taking
medication be in psychotherapy concurrently.
However, when people feel better, why should they spend the
time and money in therapy? I have heard stories of doctors
telling their patients that they shouldn't have to feel their
grief, to take medication instead. Medical ethicists debate
whether antidepressants should be prescribed to people who
are not clinically depressed but who prefer the way they feel
when taking the medication. There are many questions, and
few answers, about when and how long to use medication.
Regarding these issues, we asked Mary Killian, a psychotherapist,
and Ron Welch, a psychiatrist, the question of why go to therapy
if a pill seems to solve the problems. Also, in her article
Breaking the Taboo, Victoria Costello tells the story of one
family's process of coming to terms with questions of mental
illness and medication. We offer these views, and welcome
any response in our on-line discussion.
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A
Psychiatric View
by Ron Welch,
M.D.
I remember when,
a few years ago a particularly bright comet was gracing our
night skies. I had originally been an astronomy major and
my sons are both interested in things scientific. When I offered
to take out my telescope so they could view the show, they
shocked me with their response. "Why look at it through
a telescope when we can see it on the computer?" they
replied. They have been avid computer gamers and programmers,
spending countless hours at their screens.
Although I can appreciate that it might seem easier to experience
life within the comfort of one's own room and abilities, I
somehow felt they were missing many things this way: the ability
to learn new skills, like setting up the scope; the ability
to see things from a different perspective; the chance to
meet with others who share the love of the night sky, for
just a few examples.
So, at one level, the answer to the title question seems simple.
Going to therapy when you're at a stuck point in life offers
the opportunity to learn new skills, check out other perspectives
on your problems, experience the companionship and caring
that comes from meeting others who share your struggles, for
just a few advantages.
In my practice as a psychiatrist, I have come to see a few
common situations where it is not just desirable, but essential,
that people be in therapy of some kind, even when they require
medication for treatment.
One situation is where you have become clinically depressed
after having struggled and failed to resolve a problem over
some length of time. In such a case, just taking a pill is
like taking headache relief medicine when you're getting hit
over the head with a hammer. You may get some relief, but
if you don't do something about that hammer, you may eventually
return with brain damage!
Another situation is where you have been clinically depressed
and it is obvious that you have never been able to have fun,
think well of yourself or challenge other negative ways of
thinking. In such a case, it is essential that you have education
or therapy to specifically teach you what some researchers
have called "learned optimism," a set of skills
and a mindset known to help prevent depression in children
and help adults against a relapse of depression.
There are other conditions where "just taking medicine"
may make it harder to learn specific skills. For example,
there is some research that supports the idea that if you
have phobias and panic attacks, you may be less likely to
overcome your fears if you don't learn how to manage the feelings
of a panic attack. If you "just take medicine,"
you may never get that chance to master this skill.
I hope that if we ever have to take medicine for some psychiatric
problem, that we never stop challenging ourselves to learn
new skills and to lead fulfilling lives.
Ron Welch, MD, is a staff psychiatrist with the Kaiser
Permanente Medical Group in Santa Rosa.
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A
Time for Every Purpose
by Mary
Killian, MFT
Adjusting to my
mother's death and brewing about a lost relationship were
depressing me. I was making an effort to care for myself;
I was journaling, meditating, and exercising again. But I
was really down. I was starting to isolate. And my psychotherapist
was away for 3 months. The night of the presidential election,
I stayed up late watching the results unfold. The next evening,
short on sleep, sinking emotions enveloped me to the core.
The sobbing felt bottomless. Stories of despair, personal
and national, ran in my head.
I had experienced several depressions previously in my life.
Psychotherapy had helped change that; but the depression was
back, in spite of my attempts at self care. This time I knew,
however, that the negative thoughts were not true. I also
knew that by letting them spin, the situation would worsen.
I reached for help. I decided to try antidepressants for the
first time. They successfully soothed my negative feelings
while I rebuilt my connection to a world of possibilities
and love. I am fortunate that a short period of medication
allowed me to find my way back. I drew upon tools and experiences
from years of therapy. Without these, the depression would
have persisted below the surface. An antidepressant can change
brain chemistry and feeling states, but only experience can
change our understanding and way of being in the world.
Experiences born in psychotherapeutic relationships have given
me a new foundation over the years. I have learned that my
true feelings can be understood and shared with another. And
I have learned to have compassion for my feelings, to care
for myself, and to relate in healthy and satisfying ways.
Therapy offered me deep and lasting, changes; medication served
as a tool to relieve intense symptoms while I regained my
balance. I am grateful for both.
Mary Killian, MFT, has a private practice with a focus on somatic psychotherapy and mindfulness.
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Breaking
the Taboo, Asking for Help
by Victoria
Costello
In a dream, I'm
a would-be contestant on the game show Who Wants to Be A Millionaire.
To qualify for the next round, I have ten seconds to put important
milestones from my life in chronological order. Why is this
so hard? Before I can open my mouth, Regis begins a play by
play of my first four decades while fragmentary scenes flit
across a screen.
"You're walking down the aisle of your first communion.
Wait, now it's a wedding."
"I see two children."
"But then a lonely Christmas."
"You're at a window. There's a fragile boy in your sights,
a toddler squirming in your arms."
"You're at a computer. There are bright lights, your
name is called - Wow, you've won an Emmy!"
"Now it's a hospital waiting room. The boy is diagnosed
- they say it's schizophrenia."
A buzzer rings. Stunned, I'm out of the game.
I had seen the signs but had no reason to put them together
or seek professional help. Alex was a dreamy child; some thought
aloof, I thought happy in his own thoughts. But our divorce
hit him hard. Within a year he'd hardened enough to be of
interest to the junior high gang chieftains. This was a "nice"
neighborhood in Santa Monica where fourteen-year-olds were
recruited to sell pot to twelve-year-olds. Six weeks in wilderness
therapy helped us skirt that particular nightmare. That, and
a year in a small, nurturing private high school in Ojai where
his interests graduated from Snoop Doggy Dog to Lawrence Ferlinghetti.
I took a breath.
Then a year later, a school counselor called. Alex wouldn't,
couldn't leave his room. Perhaps most telling was his sudden
refusal to wear shoes, saying he needed his feet to feel the
ground. I finally began to understand, and let the tears come.
Until then, motherhood had provided the only unadulterated
joy in my life. Without it I've feared that I would opt out
of this life. But I never went beyond thinking about it. As
it turns out, I had to be there for my son's unraveling, and
for my own deliverance.
Both were officially announced on the same overbearing August
day in a sterile Los Angeles medical suite. I was with Alex's
first psychiatrist, struggling to give him a complete family
medical history. But, in my mind and body, I'm back on the
game show, shut down, exhausted. Pushing the fog away, I finally
begin the sad family litany.
"Dad died at 46 from lung cancer."
"My younger sister had a heroin overdose at 33; my mother's
heart attack came a year later, almost to the day."
"Oh, I suppose you should know Daddy was an alcoholic.
They always blamed it on his being orphaned so young."
The doctor writes, looks up. "Grandparents?"
"They said his mother died in childbirth, and grandpa
was hit by a train - I guess he was just laying there when
it happened. Nobody ever wanted to talk about it."
The doctor put down his clipboard, considered for a few interminable
moments before asking, "Has it ever occurred to you that
your grandfather's lying on the tracks may have been an intentional
act?" I was stunned. The moment was totally surreal.
"No, never... until now." There, in my painfully
familiar haze made all the worse by the shrieking demands
of my son's immediate jeopardy, I was thrown a lifeline. At
forty-six, this exchange somehow jarred me enough to abandon
whatever dangerous mix of pride, denial, and aversion to prescription
drugs had kept me from treating what I'd long known in my
heart was my own serious depression.
It was suddenly easy to identify my own symptoms. The hopelessness
that always lurked in the shadows of even my best times, the
black days in high school and college. Achieving enough, rarely
finishing anything, always keeping busy to avoid sinking.
I'd been aware of the medication option for at least a decade.
Several close female friends went on Prozac and swore by the
changes in their lives. Perhaps looking for reasons not to
consider it for myself, I saw only what looked like a new
flatness in them. Could it be I missed the drama we'd always
shared? The psychiatrist handed me two prescriptions, one
for Alex, the other mine.
In contrast to my near instant euphoria after starting on
an antidepressant, Alex only begrudgingly began his anti-psychotic
drug. Fortunately, he also continued in therapy. An MFT who'd
sent Alex to the psychiatrist for a consultation then saw
him once a week for a year and a half. With his medication
creating the space for healing, therapy helped Alex navigate
an internal battle that seemed to affect nearly his every
moment. He once described the difference after starting Zyprexa
saying, "Now, sometimes instead of having 300 thoughts
at once, I have only one or two." "My God,"
was all I could say.
We all noticed that Alex seemed so much more present. And
he was able to function again in school, even sleep through
the night (both had become impossible before the medication).
But I was also aware that he never fully accepted his original
diagnosis. In fact, he was often hostile to it, preferring
to describe his difficulties as a problem of the heart, not
his brain. Two years later, to his doctor's dismay, and initially
to mine, Alex shunned his wonder drug, saying simply, "I'm
O.K. now." He explained that as an artist (a painter),
he couldn't tolerate not having access to all of his brain,
especially his creativity. And, he said, the medication took
that away from him. Amazingly, once off his little yellow
pills, it became clear to me that he'd been progressively
getting better, not just controlling his original symptoms.
On or off the medication, his disordered thinking and speech
were now much reduced. And, I realized, the grogginess that
had slowed him down recently was actually a side-effect of
his medication.
I believe - without medical validation - that during the time
he took it, my son's anti-psychotic drug helped him rewire
what in his brain (and perhaps, by extension, his heart) had
been going astray. Still, intuitively, Alex knew that from
this point on, he needed to be on a trapeze without a net.
And, although he still couldn't handle much stress, he had
started wearing shoes again.
We made two different choices, my son and I, the right ones
for each of us. My antidepressant felt akin to a daily rewiring.
Suddenly I understood how other people seemed to glide through
so many things, while I regularly fell emotionally to the
bottom of so many situations. "Wow," was all I could
say when I too started to glide. I too felt so much more present,
finally people were just people, and finishing things was
a given.
There is no question that the bioenergetic (body-oriented
therapy) and other counseling I'd done in my twenties and
thirties helped me break through enough old pain to function:
to marry, be a mother, work in a tough business (television),
even win a few awards. But I believe depression gets harder
as you get older, and my life today feels 180 degrees different.
I may revisit this choice at some point, but frankly I doubt
I'll change it. I've already spent too much time in the dark.
When I look at Alex, sometimes I can still see the curious,
dreamy little boy, now a quasi-independent young man who laughs
too easily for some, but who finds inspiration in the smallest
things and produces beautiful work at art school. Although
he's in the world functioning as well or better than many
of his peers, one of the words I still hear used to describe
him is "eccentric", defined by Webster's as "something
or someone who moves in elliptical not concentric forms."
Part of my own work now is to better understand how and why
our cultural fear of the abnormal, i.e., the elliptical, hampers
acknowledgment and treatment for mental illness and deprives
all of us of life's fullness.
In prayer, I often picture the gifts of healing that Alex
and I have received as blessings that can travel across distance
and time. I then envision this healing touching my poor Grandpa,
then Dad and little sister. Each ended their life living in
a state of despair that is now just a distant memory to me.
Thinking of them, I feel both deep sorrow and joy. We had
finally broken the family taboo, Alex and I. We had asked
for and received help.
Victoria Costello has
diverse experience as a manager and fundraiser for nonprofit
organizations including the UN Population Program and National
Audubon Society and a decade working as an Emmy Award-winning
writer and producer for television. She also brings her
perspective as a beneficiary of therapists and spiritual
guides found, just in time, over the greater part of a lifetime.
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