Drugs are (not always) the answer.

January 24, 2005 7:15 AM

Why is it that whenever someone asks a question about psychological issues and says s/he doesn't want meds, all the pushers show up? Whenever it goes the other way, those who take meds attack whoever might suggest they aren't best. Is it too much to ask for the same respect you demand?
posted by dame to etiquette/policy at 7:15 AM (55 comments total)

Because, in secret, we're all arm-chair psychiatrists?
posted by BlueTrain at 7:22 AM on January 24, 2005

dame -- attack? that's a little harsh.

i think that while the taboo around seeking help via therapy may be fading, there's still a HUGE dark, evil cloud around taking happy pill meds. i can't speak for the others, but what i was trying to get at was don't close yourself off to the idea that a tandem course of talk therapy and pills might be the ticket. i think far too many people go into therapy with the idea that pills arent' for them, like that would mean they were really crazy or something. what i wanted to assure anon was that you can take pills and be a normal person.
posted by heather at 7:28 AM on January 24, 2005

Wait, if I parsed that right:

When someone says they don't want to use meds, people who use meds show up, ignoring the poster's request.

When someone says they do want to use meds, people who don't use meds show up, ignoring the poster's request.

Why is your phrasing tilted to focus only on the folks who push meds? Seems like both sides, meds and naturals, have their jerks. If the phrasing was due to the focus on this thread, why the counterexample ("Whenever it goes the other way") with the same focus on the same group?
posted by Bugbread at 7:32 AM on January 24, 2005

Dame, in the psych-related threads I've read, people have generally responded sincerely about the things that helped them, including medication. I just skimmed the thread you've called out. The questioner specified "avoid medication", and the answers seemed pretty respectful of that. I didn't see an attack; did Matt do some deleting? Calling people pushers makes this MeTa unlikely to be very useful.
posted by theora55 at 7:36 AM on January 24, 2005

Oh, take a pill, already. ;)
posted by jonmc at 7:41 AM on January 24, 2005

I agree that offering advice after it's specifically mentioned that you don't want it can be annoying (it happened to me once and it really irked me), but I don't see anything anyone could even remotely call attacking in that particular thread - it's disgustingly civilized.
posted by iconomy at 7:42 AM on January 24, 2005

Unless a lot of comments got deleted, I don't see the problem. I counted two or three people saying that meds worked for them, along with other observations they had about their specific cases. And one person specifically said that meds should not be the first option. It looked like a good blend of advice and personal anecdotes (you know, what people look for from AskMe). So what's the problem?
posted by goatdog at 7:43 AM on January 24, 2005

Bugbread: Because this is what I got a bug up my ass about today. It was that metaphorical straw.
posted by dame at 7:44 AM on January 24, 2005

Why? Because people think, on both sides of the equation, that they may have something to add that the poster may not have thought of. I think if people are being respectful and answering the question, especially if they acknowledge that they read the post but think they have something to add, I don't see where the harm is. If someone is asking for a way to deal with terrible malware problems on their PC and someone says "I had that same problem and here is how I solved it, you may not know that Macs don't have the same sorts of malware difficulties" I see that as an answer to the question. In many cases the poster may just think they have information that the original question asker may not have thought of. In Heather's post for example "Hey, I was feeling like you are, and this is why something I thought I didn't want was something I wanted...." I think is entirely appropriate. Where is the attacking?
posted by jessamyn at 7:46 AM on January 24, 2005

dame, and others, please give us a break from your hysterical pill agenda. Thanks.
posted by orange clock at 7:47 AM on January 24, 2005

I do think, though, that (if rephrased), it's a valid issue for discussion, not in an angry "This should be stopped!" way, but a "Should this be stopped?" way, in that I see it carried out over and over again in various places (largely non-Mefi) about the Windows/Mac discussion that Jessamyn touches on.

First, from what I can tell, everyone in this particular med/nonmed thread has been showing very good behavior, and the number of people providing non-med advice is great enough that the med folks are not overwhelming the post.

In general, though, to what degree should responses comply with the poster's requests?

I think it just becomes a matter of quantity. There is such a thing as "helpful but off-topic" answers (telling someone about the benefits of a Mac over Windows for a certain problem, even if the poster has said they don't want to use/buy a Mac), but the problem occurs when the amount of helpful but offtopic answers becomes too great in comparison to helpful ontopic answers. I don't know what the magic ratio is, but I'd say something like 15% would be low enough that I wouldn't get particularly mussed about people giving advice regarding something I specifically excluded in my question. That number probably varies from person to person.

I guess my rule of thumb would be, "If nobody or few people have said it, it's OK to say, as long as it's helpful, non-incendiary, and tastefully phrased, but if there are enough other helpful off-topic responses in a similar vein, I would avoid adding more unless the original poster expressed interest in it."
posted by Bugbread at 8:04 AM on January 24, 2005

Because most people are basically insecure, and will advocate their religion or cure for others to reassure themselves.
posted by inksyndicate at 8:07 AM on January 24, 2005

I think that this is a heated issue, with partisans on both sides. I posted to the thread indicated, and it seemed as if everyone was being respectful and I thought it was just fine. Although I am not pro-pill, I do think that people should think about medications when psych issues come up, and decide for themselves. That makes it a valid suggestion even if they were cautioned against in the question. In other words, an answer along the lines of "Í never wanted to take meds either, but they were very helpful for me," seems like a perfect response.

What I think is regrettable is when people's responses invalidate other ways of dealing with problems, when those ways have worked for other people. This is true for any of the problems that might get discussed, but seems to be exacerbated around things like diet, psych, religion etc, that people feel passionate about.
posted by OmieWise at 8:17 AM on January 24, 2005

Were comments deleted from the thread? I only saw one comment regarding meds that basically suggested that the poster not completely discount them.
posted by spaghetti at 8:33 AM on January 24, 2005

Dame, I just read over the thread and can't imagine how you got 'attacked' from any of the responses is beyond me.

The poster said, "I'd also like to avoid medication."

That isn't quite the same thing as saying, "I will not take medication." There are things we would all like to avoid but sometimes it's not possible -- when dealing with an individuals mental health it is foolish to arbitrarily rule out a course of action that might help. Not to point this out would be doing the poster a disservice.

Nobody ever said that when posting to AskMeFi you would like the answer.
posted by cedar at 8:51 AM on January 24, 2005

Spaghetti: Looking at the timestamps, it seems unlikely, but not out of the question, that anything has been deleted. Dame's callout was at 07:15 PST, and I read the page by 07:32 PST, at which point there wasn't anything particularly questionable. Off-hand, though, I count about 4 comments that suggest that meds might be a good idea, but none of them are particularly overhanded.

I suppose the deletions could have happened before the callout (the post itself was from 17:15 PST yesterday), but then it wouldn't make a lot of sense to call it out, especially not to mention that the callout was related to stuff that had been deleted.
posted by Bugbread at 8:55 AM on January 24, 2005

dame, these are the dangers of using this site as a ER/clinic/support group
posted by matteo at 9:02 AM on January 24, 2005

Nobody ever said that when posting to AskMeFi you would like the answer.

hear hear!
posted by jessamyn at 9:13 AM on January 24, 2005

MetaFilter: Nobody said you would like it.
posted by Man O' Straw at 9:25 AM on January 24, 2005

In general, though, to what degree should responses comply with the poster's requests?

To the extent that your experience tells you what a useful reply is, and to the extent that your experience tells you that the request is reasonable?

"I'd like to avoid medication" isn't a crazy thing to say, but it's also not entirely realistic. For some people, meds are a necessary part of a complete regimen.

It seems to me that "Sure, and you'd go about doing so in ways X, Y, and Z. But you should be prepared for the possibility that you can't easily avoid medication." isn't anything rude or dismissive; it's just the voice of someone's experiences.
posted by ROU_Xenophobe at 9:34 AM on January 24, 2005

I think the people who spoke about meds did so in a respectful, non-evangelical way, so it seemed ok to me. It is a fact that many people have all kinds of fantasies about meds, that they are poisonous, that they are miraculous cure-alls, that they brainwash you, etc.

When people who are actually taking these medications feel comfortable doing so, I think it can be really helpful for them to be open about their experiences, as it helps inject some reality (*both* positive and negative) into the issue of psychiatric medications.
posted by jasper411 at 9:44 AM on January 24, 2005

If this is the proverbial straw, where is the proverbial haystack?
posted by Captaintripps at 10:00 AM on January 24, 2005

...all the pushers show up

Give me a break. That is a completely hysterical way to describe the responses that mentioned medication, which, for reference, were:

* I know you don't want medication, but if they find that you have a disorder that requires medication, it really can be the best thing for you. I feel ten thousand times better now that I am medicated than how I felt before. It's just like taking meds for any other illness.

* If you specifically don't want meds, you probably don't want to start your search with a psychiatrist.

* i've had years of therapy, but always avoided medication and would endure cyclical bouts of depression. last year was a bitch and i finally decided that i really had no good reason not to try. i feel a gazillion times better. it's a huge step to take, but well worth the long term benefits.

* Within one session he was able to figure out a med that worked for me based on discussion of my family history and the history of the meds that didn't work. I'd say go see the real deal to begin with and don't bother with people who don't have both the medical and therapeutic training.

* Meds should never be the first line of defense, IMO; they're prescribed way too easily these days and very often will just be treating the symptoms and not the underlying cause.

Which of those are the "pushers" you refer to? I think the only person grinding an axe here is you, dame. This is a poor MeTa call-out.
posted by pardonyou? at 10:05 AM on January 24, 2005

dame - once again you frame the problem as the wrong people showing up to the thread, instead of focusing on the helpfulness of the answers given. Could you please raise these issues in a more shrill and confrontational way? You're so tactful about it that I fear many will not take notice.
posted by scarabic at 10:07 AM on January 24, 2005

i'm with inksyndicate.

And this meTa thread is not an occasion to pile on dame--at least it shouldn't be.
posted by amberglow at 10:22 AM on January 24, 2005

Oh but I love big smooshy piles amberglow . . . it's so squirmy and hot.

Really, it is just a sense I have that every time brain-shrinking comes up, people who do take meds get up in arms if someone suggests they aren't necessary, yet are happy to say "Take meds!" even if someone says they aren't interested. It bugs me. Today it bugged me more than usual. Some people agree and some people don't. That's okay.

As for the pushers bit, I still have to remind myself: People cannot hear the silly voice on the internets.
posted by dame at 11:00 AM on January 24, 2005

It bugs me. Today it bugged me more than usual. Some people agree and some people don't. That's okay.

You might have a better point if you linked to previous posts that had more eggregious offenders. As it stand, though, your example was weak and therefore your point was completely missed. It looks (to strangers without an understanding of your thought process) like more of a personal pet-peave and "way to control users" than a genuine call for more on-topic comments, which I'm sure it is.
posted by BlueTrain at 11:07 AM on January 24, 2005

Saying that people can't hear the tone of voice over the Internet is a common defense when someone is caught doing something they later wish they hadn't. It is not especially difficult to convey irony over the Internet, and you didn't. Given that you were starting a pointless MeTa thread about something, the most reasonable assumption for anyone reading is that you were in earnest. Also, given your previous statement about straws and bugs up your ass, your later claim that your tone was misunderstood rings false.

Perhaps you've never heard the story of the little MeFite who cried "Wolf!" When so many people bring so many trivial gripes toe MeTa, it's more likely that people will ignore more reasonable complaints.
posted by anapestic at 11:13 AM on January 24, 2005

people who do take meds get up in arms if someone suggests they aren't necessary

Because that's a dumb thing to suggest. Medications may or may be useful to one degree or another, or not, for any individual person, as might any other possible form of therapy. For someone to suggest up front, knowing nothing about the person in question, the particulars of their problem, any other medical problems they might be having, and the particulars of their idiosyncratic biochemistry, that medication -- or any other form of scientifically-verified therapy -- is somehow "unnecessary" is simply ignorant, whether the problem at hand is depression, headache, or diabetes.

yet are happy to say "Take meds!" even if someone says they aren't interested

The poster said that he or she would prefer not to take meds, which is not the same thing. People respond back to caveats like that, from what I can see, in two ways:

(1) Bitter experience tells me that you might not get that wish, so be prepared. That's all I see in that thread.

(2) I thought that too, and I stayed bad, and then I started on [foo] and it helped, where [foo] might be a medication, or a form of talk-therapy, or something else that the poster said he/she didn't want to try. Which is direct experience with the same problem and the same starting point leading to an at least partial solution. That's what we call "being helpful," even when the solution isn't what the poster hoped.
posted by ROU_Xenophobe at 11:17 AM on January 24, 2005

Why is it that whenever someone asks a question about psychological issues and says s/he doesn't want meds, all the pushers show up?

Because psych meds often carry a stigma, and the "pushers" (no way you can worm out of that one, btw) realize that the stigma is usually unwarranted, and that said stigma might affect decision-making and therefore delay healing. Reactions like yours perpetuate the stigma, so thanks.

If someone asked me for advice on any other health issue, I would suggest they look into a balanced approach--diet, activity, habits, relationships, personal history, chemical imbalances, etc. all come into play. Meds can help with some of these things whether it's your kidneys, your joints, or your brain that's not working.
posted by whatnot at 11:50 AM on January 24, 2005

Meds are not the total answer, but for some of us, sadly, not-meds are not the total answer either.

I will say, that speaking for myself, I am quite capable of handling any anti-med people that come my way, in a firm and forceful manner. And God help you if you are a Scientologist.
posted by konolia at 12:00 PM on January 24, 2005

Maybe we get cranky when people equate our legitmately prescribed medicine with recreational street drugs.
posted by stet at 12:36 PM on January 24, 2005

When a question that is highly personal is brought up it is hard to avoid not getting personal in return. In these types of questions posters will respond with, "In my case ..." unless they are a doctor, counsellor, head shrinker - human nature to do so. It is no different than asking, "what are the best treatment options for psoriasis?" which have both drug and non drug related treatment options. As for the medication angle there is so much stigma attached to mental illness some equate being prescribed medication with being ill and somehow seeing a therapist as being less evil. Drugs are a form of therapy just as the over 300 brands of psychology are therapy. I don't think the responses that included personal anecdotes about medication were out of line and found the comments very civilized.
posted by squeak at 1:28 PM on January 24, 2005

People are emotional in defense of their crutches. This is hardly news.
posted by rushmc at 1:44 PM on January 24, 2005

And God help you if you are a Scientologist.

Funny, I feel exactly the same way about Christians!
posted by rushmc at 1:45 PM on January 24, 2005

People are emotional in defense of their crutches. This is hardly news.

Correct, rushmc. Because it is physically impossible that someone could have errant neurochemistry. Therefore all people who use medication are weaklings who just can't deal and rely on crutches that ubermenschen like yourself have no need of.

What a load of utter horseshit.
posted by Ryvar at 2:12 PM on January 24, 2005

ubermenschen

Dude. What's with the plural? Surely you don't mean to imply that there are others who have reached the same lofty heights to which rushmc has ascended? (See: irony. Not really that hard to do online.)

Seriously, though, the fact that AskMe says specifically not to be a dick in the threads doesn't mean that it's cool to be a dick in MeTa merely because there's no little "don't be a dick" at the bottom of the page. If you have nothing better to do than to make fun of people who take medication, then you have bigger problems than they do.
posted by anapestic at 2:38 PM on January 24, 2005

I mentioned meds because I simply can't tell from the askme post whether the person is in a lot of personal hell, or not. If someone had asked me prior to my diagnosis if I needed meds, I would have said no. I did not really want to be on meds either. But I have since learned that meds are a necessity for me. I could not function without them.

So I wanted to just let the poster know that there was a possibility that they may need meds, if they happen to have a disorder. If they don't have a disorder, then congratulations. I agree that meds should not be a first line of defense, and I even said they should go to a therapist, and not a psychiatrist, first. But if you happen to have something like bipolar, then you really need them.

I just wonder how many more generations it's going to take before everyone recognizes that mental illnesses are physical diseases, and needing meds for some of them is a necessity, not a crutch.
posted by veronitron at 3:04 PM on January 24, 2005

Uh... Not to speak for rushmc, but crutches are necessities for many people with certain physical disabilities. Your points that mental illness is often a physical disability means that "crutch" is actually a very good descriptor for meds. Needing meds is like needing a crutch.

The question is why do we speak of "crutches" in the negative?
posted by Man O' Straw at 3:22 PM on January 24, 2005

Yeah, and diabetics who use insulin therapy are sissies. And don't even get me started on those motorized wheelchairs.....
posted by availablelight at 3:26 PM on January 24, 2005

Man O' Straw: the word 'crutch' in the context rushmc was using it in generally refers to personal weakness or innate failing. ie "Religion is a crutch for the weak-minded."

For those who are simply born mentally ill, or with a strong genetic predisposition easily triggered by environmental stress, implying that there is some type of personal failing at work is wildly unfair at best, and more frequently just outright ignorant bigotry.
posted by Ryvar at 3:32 PM on January 24, 2005

Because it is physically impossible that someone could have errant neurochemistry. Therefore all people who use medication are weaklings who just can't deal and rely on crutches that ubermenschen like yourself have no need of.

I don't know who you're arguing against, but I said none of that. I agree with anapestic: stop being a jerk.

ie "Religion is a crutch for the weak-minded."

Man O' Straw's point stands, because no one implied that the weak-minded didn't need that crutch.
posted by rushmc at 3:44 PM on January 24, 2005

Ryvar: I understood the context you (and pretty much everyone after you) were reacting to. I don't know rushmc, so I won't make any assumptions about his intended context. I just thought it might be a good time to caution against using the same kinds of negative language and stereotypes re: crutches in defending against the perceived insult. There's an insidious self-loathing in the statement "I need it, but it's not a crutch," that is not helpful to the cause of enlightening people about the treatment requirements of the disabled - of any variety.

/language soapbox
posted by Man O' Straw at 3:47 PM on January 24, 2005

I think it might be a good idea to not use the "crutch" comparison until after the stigma around crutches is taken care of. Until then, it's just begging for misunderstanding, confusion, and general wankery, and there are many other, less contentious terms to choose from.
posted by Bugbread at 3:54 PM on January 24, 2005

bugbread: Agree 100%.
posted by Man O' Straw at 4:02 PM on January 24, 2005

Man O' Straw's point stands, because no one implied that the weak-minded didn't need that crutch.

This is the problem - you see people with mental illness as inherently 'weak-minded.' Inferior. Yet many of the most brilliant scientists, engineers, artists of every variety from every culture have been mentally ill in some form or another - usually Asperger's for engineers, and manic depression for artists.

Mental illness comes in many forms - some make rational thought difficult or impossible, but many others (the most common types, for obvious natural selection reasons) 'merely' play havoc with your emotions. And that does not make a person weak-minded, merely unpredictable.
posted by Ryvar at 4:14 PM on January 24, 2005

This is the problem - you see people with mental illness as inherently 'weak-minded.'

No, you've got it wrong. I see religious people as "inherently weak-minded." I see people with mental illness as simply "differently minded" (which sounds like but is NOT analogous to the ridiculous PC "differently abled").

Every normal person, in fact, is only normal on the average. His ego approximates to that of the psychotic in some part or other and to a greater or lesser extent. —Sigmund Freud
posted by rushmc at 5:19 PM on January 24, 2005

Because psych meds often carry a stigma,

This is so far from being true, in NYC anyway, that it's almost funny. One reason I try to emphasize the 'don't start with meds' line is because in my experience, you tell a doc that you're not particularly happy, and you have a script for prozac in your hand after 10 minutes. I'm not sure I know a single person who has never been on anti-depressants! Well, I'm sure I do, but the point is, I would not be surprised by anyone having been on anti-depressants. I know some very stable normal people who have been prescribed meds just because they were having a rough week, basically.

Yet many of the most brilliant scientists, engineers, artists of every variety from every culture have been mentally ill in some form or another - usually Asperger's for engineers, and manic depression for artists.

"mental illness" is a very subjective term. The diagnoses depend on a number of 'symptoms' or 'traits' being present. Maybe those brilliant artists are just 'artistic personalities' and not 'mentally ill'. Maybe struggling through bouts of depression isn't completely worthless and better sidestepped via chemical manipulation. I am by no means an absolutist about this, and certainly recognize that for some people, it saves their life. But these days, it has become a 'disease' to feel unhappy or frustrated or unsure what to do next, and often this is treated not by trying to work out what causes these feelings, but by simply erasing the feelings. In the thread I compared it to pain meds; my point is that while easing pain is important, it is also worth trying to determine why that pain is occurring and working to see if there's a more fundamental, long term strategy for getting past it.
posted by mdn at 5:23 PM on January 24, 2005

Maybe those brilliant artists are just 'artistic personalities' and not 'mentally ill'.

Maybe. That's why some of us were saying that meds shouldn't be the first response of the doc/therapist. However, should that artist turn out to be a manic-depressive, or schizophrenic, or the like, then meds are in order.
posted by veronitron at 5:55 PM on January 24, 2005

Rushmc, if I was weak-minded I would be dead by now.

And as to Christians being weakminded, you have obviously never met Chinese Christians who are part of the underground church. The guy that was supposed to come to our missions conference has been arrested and no one even knows if he is still alive (He's a diabetic.)

These people have a strong faith under the most difficult of cicrumstances and they know the price they have to pay to have it.
posted by konolia at 6:30 PM on January 24, 2005

dame, i agree with you for the most part about your noticing this over time, and this is yet again one of those things mefi tends to lean (in terms of vocal comments if not in actual 20000orso individuals) one way on...and i agree with what inksyndicate and amberglow say above, in conjunction with the later comments about it being overcompensation, an overly defensive sort of reaction to the stigma people still recognize our culture has about meds. i think people who do find them useful--and someone above mentioned in more general terms that people are going to be tempted to talk about what worked for them even when the question posed doesn't quite fit; that's hardly a pill-only thing, and it's understandable--get a little defensive when they see something like "and preferably no meds" because they partly see it as implying their use of meds is a last resort and somehow thus not the best advice (when clearly it was for them). it's something one can see the reasons for, but i do totally agree with your recognition of it...if not wholly in that thread, it's happened in others for sure. just to say you're not alone in seeing it.
posted by ifjuly at 7:18 PM on January 24, 2005

ifjuly: Just wanted to state that it's not that I see any implications that my use of meds is a last resort. Perhaps it's because I belong to a bipolar support group, and new people join occasionally who say that they don't want to take meds. Perhaps it's because I went through over 15 years of my life being a destructive force before I learned that I needed meds. When I see someone who needs help, but seems to be denying themselves an option that possibly could help them, I have to mention the meds. Yes, it's partly because it's what helped me, and I don't want to see a repeat of my story (I don't want them to hurt themselves for 15 more years if meds could help them).

It really seemed to me that the person didn't want meds due to the stigma, which is why I said it's like taking meds for any other illness (and someone here is lucky enough to live in a place with no stigma, but that's not the norm, especially in rural areas).

They might not need meds, which is why I said they should see a therapist first and find out what the problem is. But on the chance that they are like me, and have a disorder that requires medication, I want them to keep that possibility in mind, and not reject it outright.
posted by veronitron at 7:51 PM on January 24, 2005

Thanks to people with reasoned responses, especially veronitron (though I would like to emphasize that there are people who are not down with meds for reasons unrelated to stigma).

Scarabic: Like I said in the other thread, it has nothing to do with the people; it's what the people say.

Finally, I have no desire to "control" Metafilter. I would like it if commenters could respect posters' wishes and avoid being hypocrites as much as possible. Seeing as my only power is in making threads, I hardly think those who acribe me nefarious intentions need worry they will wake up to a world where I am Queen of Metafilter. So don't worry. You're safe.
posted by dame at 10:23 PM on January 24, 2005

I don't know who you're arguing against, but I said none of that. I agree with anapestic: stop being a jerk.

As I'm sure you know, I was talking about you, not Ryvar. When people talk about a "crutch," the connotation is always negative, except perhaps when the word isn't being used metaphorically, and since no one was talking about actual crutches here, your use was obviously metaphorical. What you said was offensive, and trying to weasel out of it after the fact is mere cowardice.
posted by anapestic at 3:34 AM on January 25, 2005

In that case, I withdraw my agreement with you.
posted by rushmc at 8:22 AM on January 25, 2005