Shirah Vollmer MD

The Musings of Dr. Vollmer

Medication Meaning

Posted by Dr. Vollmer on May 9, 2012

Donny, forty-three, fights with himself over taking psychotropic medications to help his mood. He feels his medication symbolizes his “weakness,” his inability to help himself. His shame around his medication is projected outwards such that he feels that I am “forcing” him to be on medication. By making me the parent, he takes on the role of the child who is helpless and resentful. Over the years we have discussed this dynamic at great length. “I see your point,” Donny says, “but I have to say it is hard to hear that I am acting like a child.” “Yes, I know it is hard to hear that, but maybe if we can think about this together we can come to understand how hard it is for you to take responsibility for your decisions.” I say, trying to help Donny take more ownership over his life. “I just wish I were not on medications.” Donny repeats. “It is really your decision. Again, this is an example of how you are able to choose being on medications or not, and yet your words make it sound as if I am forcing you to take psychotropics.” I say, rounding this bend. “I am going to think about what you are saying without feeling hurt by it. I think you are saying something important, but I am not sure I can hear it right now.” Donny says with his characteristic sweetness.

6 Responses to “Medication Meaning”

  1. Jon said

    I can understand Donny’s desire to not take the psychotropic medication for reasons stated. A weakness, and inability to help oneself, is something to be avoided, if possible. I assume that the psychotropic medication is the simplest way to treat his mental problems. However, is it possible that there are other approaches – talking things through, diet and exercise – that might also be effective in treating his condition? If not (and come to think about it, even if so), I see that breaking the child/parent dynamic that has developed is necessary for a good mental well being.

    • Hi Jon,
      I am intrigued by this notion that medication somehow represents a mental weakness, even though taking antihypertensives, for example, does not. Medications are a tool to aid in the feeling of well-being. One’s thoughts about those tools bring up one’s ideas about personality formation and ego strength. Like all of psychotherapy, the prescribing of medication becomes a canvas in which the patient projects their insecurities. It is not that medication is the simplest way to treat his mental anguish, it is that it is one tool amongst many which will help him lead a more fulfilling life. Medication is not a substitute for lifestyle changes, but again, it can help one want to make lifestyle changes. Thanks, as always for your comments.

      • Jon said

        Hi Shirah,

        Let us look at your example in some non-extreme cases. Antihypertensive medication can be given to a patient with moderate blood pressure issues. However, if I understand correctly, exercise and diet can also reduce high blood pressure as well. Could there be an analogous situation with psychotropic medication and mental distress with some non-external-chemical solution?

        • Yes, they are indeed analogous. The issue is that people usually do not feel shame about taking antihypertensives, whereas many folks do feel shame over psychotropics. Sometimes diet and exercise don’t work, so medication is needed. Where is the shame in that? Thanks.

  2. Shelly said

    I know people who try to control their diabetes and high blood pressure through diet and exercise alone, preferring these methods over the side effects of the medications. It is not necessarily the fact that psychotropics alone are shameful, it is the fact that taking them symbolizes to everyone that someone has a mood disorder and that alone is stigmatizing. If you recall, in the past, women had ‘hysteria’ and the mentally ill were shut away in asylums. Today, people with mental disorders are denied health coverage because it’s a pre-existing condition or are considered high risk. No wonder Donny doesn’t want to be stigmatized by taking medications for his disorder. Imagine what would happen if his insurance company would tell his employer why they were denying him coverage!

    • Hi Shelly,
      There is external and internal stigma. I appreciate the external stigma, but this blog is trying to highlight Donny’s internal stigma, where the medication signifies to him the defects of his personality. In other words, the medication highlights his insecurities. Maybe external stigmas could go away if people could grow more comfortable with themselves. I know this is a longshot, but I think it could slowly happen. Thanks.

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