Doug Goldschmidt, Ph.D., C.S.W.
Many of us living in these times find ourselves with strong feelings
or thoughts that significantly affect our lives. These thoughts or feelings may
include depression, anxiety, restlessness, strong fears, and obsessions about
people, sex, places, and things.
Some of these feelings may be due to our life situations - a breakup
or death, job changes, moving, illness, or coming-out to be who you really are.
But many may be long-standing and increasingly debilitating. They may be interfering
with work, personal relations, and our physical or mental health or safety.
They can also interfere with therapy. Any therapy depends on the
client's ability to concentrate on being present. If you can't be present, it's
hard to be authentic. Think of this like having the flu where flu symptoms interfere
with your ability to think clearly. When we are distracted, therapy becomes a
holding action and not a focus of change.
This is where psychotropic medications may be useful. They, like
flu medications, can reduce the intrusive symptoms, allowing you to focus on therapy
and get on with your life. This way you can work on your challenges without having
unnecessary intrusions on the process.
There is often a misapprehension that psychotropics somehow "hide"
or "reduce" one's feelings or emotions. Or that you must "feel the pain" in order
to resolve it. In our judgment, this view ignores what the drugs can do. By reducing
symptoms, we can focus on underlying truths. By staying with the symptoms, you
are staying with the symptoms and may not get to the truths. The truths are always
there - drugs for depression, anxiety, mania, and the like don't make the problems
go away. Indeed, many find that they can see the symptoms just "under" the surface.
Many who are in addiction recovery are justifiably nervous about
taking drugs, seeing them as just another form of addiction and attempt to hide
reality. Here we must distinguish between addiction and dependence. For example,
few of the anti-depressants now on the market are addictive - no one enjoys taking
them as they all have side effects of varying severity. And, their affects take
days or weeks to take affect and are often subtle.
One develops a physiological dependence on them as one's brain
chemistry changes. However, the dependence is easily ended by gradually stopping
the medication.
While some of the medications used in psychiatry are addictive,
these can be largely avoided. By discussing your fears and experiences with addiction
with your psychiatrist, you can carefully control the use of addictive drugs (e.g.
Zanax) or substitute other drugs (e.g. Buspar) that are not addictive.
What About
Long-term Need for Drugs?
Some of us have psychological problems that go beyond what therapy
will help. For example, one of the Institute's associates suffers from chronic
acute depression. He has been on virtually continuous high doses of anti-depressants
for 10 years. The medication keeps his depression largely manageable, allowing
him to work and have a fulfilling relationship. If he doesn't take his medication
he becomes irritable, develops a "pseudo-dementia" that interferes with his ability
to talk or remember even simple things, and becomes suicidal. This problem has
worsened despite many years of therapy. Psychiatric research suggests that this
type of depression is chemical and has less than a 20% probability of ending.
Rather than rejecting the medication, he sees it as a necessity,
much as diabetics need to take insulin. As long as he takes his medication, his
health remains fine. He doesn't berate himself for not having found a "cure" in
therapy. Indeed, it was authentic process healing that has allowed him to incorporate
and integrate the depression as part of his life. It's just another part of himself
that needs to be acknowledged and valued. As Ram Das has written, everything we
encounter in life is part of our spiritual path. It doesn't matter whether we
welcome the circumstance or not - once it happens, we grow by embracing it and
making it part of our path. Denying the utility of psychotropics is like rejecting
part of our path. It's as hard to see one's path when one has a bad flu as when
you have a deep depression, overwhelming anxiety or panic, or obsessions.
No one really knows why certain problems take this course. It
is possibly due to genetics (depression and certain other difficulties tend to
run in families). It is also possible that certain problems, like depression,
arise from life problems and, over time and under certain circumstances, permanently
alter brain chemistry. In any case, we know enough clinically that people with
many chronic problems are able to live fulfilling and active lives largely because
of a successful therapy and medication to keep the brain chemistry in check.
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