Treating the hardships of life with an antidepressant medicine fails to acknowledge difficult and complex life circumstances, offering rather a simplistic, paternalistic, pharmacological sop, and can undermine the necessary and more constructive process of developing the resources to cope with adversity as best as possible.
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I rarely encountered a patient in our unit with a diagnosis of a personality disorder who had not been profoundly damaged by life circumstances. These extreme behaviours did not arise from nowhere. The usual trajectory was from a broken home, an absent or abusive father, a neglectful mother and a total absence of any form of support or nurturing, to a profound lack of self-esteem and a grim descent into drug abuse, gangsterism and criminality. These patients, and that is how they were described while in the unit, provoked an anger and a moral indignation that too often deflected attention away from the tragedy of these abject histories.
It is understandable that socioeconomic ills or bereavement are unlikely to be ameliorated by a chemical agent, whereas the more severe form of depression - which seems more probably to have a biological basis - should be more likely to respond.
Antidepressants do not make you happy - they just blunt your sensitivity to what radical psychiatrist Thomas Suze calls “problems in living”. Antipsychotics suppress - rather than remove - the disturbing phenomena associated with psychosis.
But, as important as it is to understand the sources and details of one’s pain, understanding is rarely enough. My patients come to therapy wanting the burden of their accumulated experience lifted. Yes, they want to make sense of their lives, but that is not usually their fundamental or exclusive aim. First and foremost, they are trying to get over their accumulated trauma in order to feel less fearful, isolated, forlorn, helpless, alone, anxious, or depressed. They might not be able to say it so clearly, but they are reaching for things
beyond thought, trying to make contact with essential capacities that have been sacrificed in their efforts to adapt, adjust, comply, cope, or conform.
The French psychoanalyst Julia Kristeva says, making a fine distinction, that we should find language and images that are “lucid counterdepressants rather than neutralizing antidepressants.” You want to find a way to counter your heaviness without denying it or even escaping it. You don’t want to neutralize your sadness, but you want to find ways not to succumb to it. This is a fine but crucial line to walk.