Pills or Therapy? What is best for you? – Free Ebook

For most of the history of humanity, there
was nothing at all one could swallow when

one was mentally ill. The full force of one’s
sickness had to run unchecked.

Then, in 1950, Paul Charpentier, a French
chemist working at Laboratoires Rhône-Poulenc,

succeeded in synthesising a drug called 4560RP,
later renamed chlorpromazine. When rats were

injected with it, placed in a crowded cage
and convulsed with electric shocks, they showed

none of the expected alarm and frenzy, settling
instead into a serene and indifferent mood.

When given to humans, the drug had a similar
calming effect: American soldiers in the Korean

war were able to walk into the battlefield
with total fearlessness. In hospitals, psychotic

patients who were placed on the drug became
sociable, unaggressive and ready to rejoin

ordinary life. The world’s first antipsychotic
drug was born. It would over the coming decades

be followed by dozens more seemingly miraculous
medicines, all of them playing – in ways that

their creators did not and still do not entirely
understand – with the brain’s receptors

for dopamine, the hormone held to be responsible
for excessive excitement and fear. Alongside

these antipsychotics, there emerged a family
of antidepressants, in particular those known

as SSRIs, that could increase the brain’s
levels of serotonin, the neurotransmitter

and hormone associated with uplift, motivation
and positive moods. The drugs were baptised

with names that put language to ever more
daunting uses: fluoxetine, citalopram, paroxetine,

escitalopram, risperidone, quetiapine, aripiprazole.
Whatever the particularities of each example,

modern psychiatry ended up operating with
two essential instruments: pills that could

calm us down (reducing terror, paranoia, mania,
disinhibition, insomnia and aggression) and

pills that could lift us up (alleviating despair,
moroseness and loss of meaning).

Thanks to these medicines, occupancy rates
of psychiatric hospitals plummeted, decreasing

by some 80% in developed countries between
1955 and 1990. Illnesses that had been a near-death

sentence a generation before could now be
managed by swallowing one or two pills a day.

It looked as if our unruly minds had finally
been tamed.

But the answer was not complete. All these
medicines turned out to have serious physical

side effects (being intermittently responsible
for dramatic weight gain, diabetes, kidney

malfunction and blood clots). Yet the charge
against them at a psychological level was

more fundamental: that they did not and could
never – on the basis of their approach – get

to grips with the true causes of mental illness.
At best, they could control appalling symptoms

while being unable to grapple with what, in
the individual past, had led to them in the

first place.

To be fair to psychiatry, even if this were
true, it is no mean feat to be able to offer

a person a measure of control over their mental
symptoms, given the horrors that these can

entail. Those of us who have known mental
illness from close up would – at the height

of our suffering – generally choose to be
physically tortured rather than endure yet

more of the abominations our minds can inflict.
There are varieties of mental unwellness in

which we are taken over by anxiety and foreboding

  • and paralysed by a sense that every minute

is carrying us closer to an immense and unnameable
catastrophe. We can no longer eat or speak,

we may just have to lie in a ball crying,
scratching ourselves and waiting for the axe

to fall. There are states in which we wake
up every morning with a conviction that we

need to take an overdose in order to put to
an end to the turmoil in our minds. There

can be voices inside us that do not for one
moment cease telling us that we are guilty,

shameful and abhorrent beings. We may live
in terror that we are about to lose control

or might already have done so. Our imaginations
can be haunted by images of stabbing a child

or tearing off our own fingernails. It can
feel as if there is a monster inside us urging

us to do appalling deeds and filling our consciousness
with lacerating persecutory thoughts. We may

feel our inner coherence dissolving and giving
way to a maelstrom of aggression and paranoia.

We may be so mysteriously sad that no pleasantry
or act of kindness can distract us and all

we wish to do is stare mutely out of the window
and hope to be gone soon.

With the right pills to hand however, some
of these nightmares can end. We may know our

anxiety is still there but we are granted
some distance from it, we are able to stare

at it as if it were an enraged tiger in a
zoo on the other side of a thick pane of glass.

We may not lose sight of our despair and self-loathing
but we can acquire an attitude of detachment

in relation to it; it doesn’t matter quite
so much that we are entirely awful and should

be put down. We can park the idea for a morning
in order to do some work or clean the house.

We can put off thoughts of suicide until tomorrow.
We don’t need to have a complete reckoning

with our sadistic ideas at every moment. The
crushing sadness can partially lift and we

might have the energy for a conversation with
a friend or a walk in the park. Only someone

who hadn’t endured vicious mental suffering
would dare to casually dismiss such psychiatric

interventions as a plaster over a wound.

Nevertheless, most mental illness has a psychological
history – and its hold on us will for the

most part only properly weaken the more episodes
of this painful history we can start to feel

and make sense of. Pills may be able to change
the background atmosphere of our minds, but

our thoughts about ourselves need to be challenged
and adjusted with conscious instruments if

we are to be able to grow truly well. The
genuine resolution of mental disturbance lies

in our ability to think – especially of our
early childhoods and the key figures and events

within it.

The unfortunate paradox is that illnesses
of the mind generally effect precisely the

instrument that we require in order to interpret
our lives. It is our conscious reason that

is both sick and desperately needed in order
to do battle with despair and fear; it is

the reason that we need in order to locate
persuasive grounds to keep living. This is

where pills may usefully join up with psychotherapy
to deliver a coherent solution. We might say

that the supreme role of pills is to hold
back panic and sadness just long enough that

we can start to identify why we might want
to continue living; they aren’t in themselves

the cure, but they are at points the essential
tools that can make therapy, and through it

authentic healing, possible. They promise
our minds the rest and safety they require

to harness their own strengths.

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