Drugs vs. Therapy: Which one works?

I received an email from a reader who echoes my philosophy that ideas are the cause of emotions and actions. She went on to say that she felt that psychiatric drugs cannot be the primary tool for correcting negative thoughts or actions, and, at best, they might ‘even out’ emotional instability while the subject works to correct misguided or false ideas.

Interestingly, she reflects my actual experience by saying that when meds and talk therapy are combined, it’s difficult to determine if it’s the pills or the counseling that is working. Given all that, she wonders if medications have any place in trying to correct misguided or false ideas.

Many years ago, a client told me, ‘It’s better to swim with the current than against the current. Psychiatric medication might help me swim with the current, but if I’m going to get anywhere, I still have to swim.’ If that’s the case, then how could anybody question the effectiveness of medication?

And therein lies the key. In her question, she described medication as ‘secondary.’ She’s correct when she says that the mind must continue to think and function in order for flawed ideas to be changed. In fact, she points out the importance of the individual working ‘to correct the misguided or false ideas.’

Too often, medication is prescribed in an effort to bypass that process. A doctor will spend five minutes with a patient, decide the patient is depressed, and prescribe medication. The doctor doesn’t talk with the patient about his or her problems, and will usually not even refer the patient to a psychotherapist who can get a better idea of what’s going on. This flawed process conveys to the patient that medication is the first and only option available to them.

The writer says that drugs can ‘even out’ emotional instability while the person takes responsibility for thinking. If that’s what medication is actually doing, then I agree. But in fact, that’s not what it’s doing. Very few people have told me that their medication helps, and far more have said that it either doesn’t help, or sometimes makes things worse.

Sadly, if a patient is led to believe 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. If someone simply told him that medication is, at best, a way to calm him so he can better think, he would be a lot better off.

Of course, I’m not against anything — medication or whatever — that objectively helps. What I am against is the idea of biological determinism, i.e., the view that biology is destiny, that genetics and brain physiology determine everything about a person. If this were true, a doctor could just prescribe medication for anything and everything; pretending that the patient’s ideas, attitudes and behaviors have little or nothing to do with how he or she feels. That would be more depressing and anxiety provoking than anything the patient was probably thinking in the first place.

The writer also asserted that it would be difficult to determine if the meds or the therapy caused whatever change in behavior there might be. That makes a lot of sense. People sometimes tell me in sessions, ‘I’m taking this medication and I’m doing better. But I’m not sure if it’s the pills or the counseling that’s helping. Or, maybe I’m better because the problem got better.’

Psychiatric medications rarely, if ever, clear up or cure emotional problems the way antibiotics clear up bacterial infections or a cast allows a broken leg to heal. In fact, in over 22 years as a professional counselor, I haven’t seen a single example of that. There are just too many variables that can bring on and/or change a person’s emotional state.

I maintain that the most potent factors affecting a person’s psychological state are ideas and beliefs — and the actions one takes as a result of those beliefs. When all is said and done, my advice regarding medication is to take it if it helps. And, by ‘help,’ I mean that it makes it easier to do what is your job to do anyway: To think, introspect and use your mind to reason things out, with or without a therapist. It all comes back to my client’s words so many years ago: ”if I’m going to get anywhere, I still have to swim.’