What Meds Do and Don’t Do for Emotions

Q: While I share your wisdom and identification of ideas as the cause of emotions and actions, I disagree on the subject of medicine/drugs as a tool for correction of negative thoughts or actions.

I think anxiety and antidepressants can be a great supportive engine to change. That being said, the key here is a secondary role, not a primary role. Meds can assist to help a person even out their emotional instability while they work to correct the misguided or false idea.

While I do think there is a difficulty of identifying if it’s the meds or the mental work that is working, I think that certain instances of usage help those who already have a strong cognitive foundation. Am I misinterpreting your position on meds? Do you think they serve a role in changing thoughts and actions?

A: I once heard an analogy: ‘It’s better to swim with the current than against the current. Psychiatric medication helps me swim with the current. I still have to swim.’ If medication is helping you swim with the current rather than against it, then how could anyone be against it?

That’s the key. In your question, you described medication as a ‘supportive engine’ and ‘secondary.’ You’re not ignoring the fact that your mind must continue to think and function, generated by your own free will. In fact, you point out the importance of the individual working ‘to correct the misguided or false idea.’

Too often, medication is used as a way to bypass this process. A doctor will spend five minutes with a patient, decide the patient is depressed, and prescribe medication. The doctor makes no effort to talk with the patient about the problems, or refer the patient to a psychotherapist who will talk to the patient and get a better idea of what’s going on. This conveys to the patient that medication is the first and only option available for a person with emotional conflict of any kind.

Your idea conflicts with what this doctor is doing. You’re saying the medication can ‘even out’ emotional instability while the person takes responsibility for thinking. If that’s what medication is actually doing, then I say: Great. I wish I could say it happens all the time. In fact, I know it doesn’t. Quite frankly, a few people have told me medication helps. But far more have told me that it either doesn’t help, or possibly even makes things worse. Of course, I cannot necessarily blame this on medication. If a patient is led to think that he has no personal responsibility for his mental functioning (and therefore no control over it), then he may start to feel even more anxiety and/or depression for this reason. If someone had simply told him what you already understand, that medication is at best a way to even things out so you can better think—then the person would be a lot better off. I’m here to tell you that this simply does not happen, except in very rare instances. That’s the problem.

I am not against medication or anything that objectively helps. I am against the idea of biological determinism. That sounds so heavy, but it’s a very real idea with very real consequences. Biological determinism refers to the view that biology is destiny, that genetics and brain physiology determine absolutely everything about a person. If this were true, it would make sense for a doctor to prescribe a medication for all that ails a person; to pretend that this person’s ideas, premises, attitudes and behaviors have little or nothing to do with how he feels. This is a depressing, anxiety-provoking and distorted view on a larger scale than anything the depressed or anxious person was probably thinking or doing in the first place!

You also wrote: ‘… I do think there is a difficulty of identifying if it’s the meds or the mental work that is working ” That’s right. People often comment, ‘I’m taking this medication and I’m doing better. But I don’t know for sure if the medication is the reason. Maybe I’m better because of this counseling. Maybe I’m better because the problem got better. I’m just not sure.’ I wish I could say that medication usually if not always cures the problem, the way antibiotics usually if not always clear up bacterial infections. It’s just not that simple. There are many variables which cause emotional states. I maintain that the most potent factors are your ideas, beliefs and actions you take as a result of those beliefs. My advice regarding medication is: Take it if it will help you—and so long as you define help as assisting in what it’s your job to do anyway. As the analogy says, it’s your job to swim, either way.