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In a previous piece I explored approaches to helping someone into therapy. But therapy may be neither necessary nor sufficient for treatment recovery (though it nearly always helps).
In my mental health journey, 2 years before I was hospitalized, I started twice a week sessions with a seasoned and solid therapist. Our conversations would be winding and erudite, free-wheeling and spirited. And then I would crack.
It could be a single word he said. Or an analogy I didn’t prefer. The title of a book on his shelf. A vibe he emanated. Or just the rising of an emotion I couldn’t tolerate or permit. Then I would freeze in tears and barely speak the rest of the hour. We lengthened our sessions to give room for recovery but it just kept happening.
Finally, he suggested to me, in the mildest way possible, that medication might help.
I didn’t want that. He knew I didn’t want that. He knew I needed it. I refused to even consider.
While sustained talk therapy is one of few proven “drugs”, it can be extremely hard to do at all, or comfortably, or sustainably, if uncontrollable emotions, compulsions, flashbacks, and fears are dominating the session.
You may think therapy is precisely the place for such happenings, and it’s partly true. But therapy doesn’t always feel sufficiently safe, or it cannot contain what it unearths between the appointments, or it raises new angers and pains that simply overwhelm.
There is a reason medication and therapy together repeatedly show optimal efficacy when paired: therapy can be hard and medication can make it more tolerable and rich.
So what do you do if someone you love or care for is resisting medication, either alone or as part of therapy. Here are 15 tips to guide you.
1) Talk about resistance. I don’t mean call out a person’s resistance to medication to cast blame. I mean acknowledge they don’t want to take medications. State it plainly: I see and hear that you’re against taking medications. Try to find our why. Did they take meds before and feel like a zombie? Were they forced to take meds while hospitalized? Are they afraid of side effects like weight gain and grogginess or sexual side effects? Are they terrified they’ll lose their emotions and become numb? Do they think it’s weak or a failure, and that they should be able to figure it out on their own? Are they embarrassed others will think they are sick with stigma?Do they worry they’ll be on meds their whole life? Did they try medications before in a traumatic context and now associate medications with the trauma? Did they try medication before and it just not help their anxiety or depression or psychosis or PTSD? Are they afraid they won’t be themself on meds or irreparably change their personality? Once you know more you can tailor your response. But take their resistance as valuable data. Your goal, at least at first, is not to change their mind but to understand it.
2) Share your own prescription. The best evidence is testimony. If you now or ever before took psychiatric drugs then have the courage to share that. If you can, be specific about when you started taking them, what you take them for, how they help, how you manage side effects, what you worried about and what you learned. If you don’t or didn’t take these drugs but know someone who has, share that some of your closest family or friends are on medications too. Be clear that you don’t judge them for it. Stigma hates company and is felled by wholehearted acceptance.
3) Don’t prescribe. You’re not a doctor and don’t need to be. Leave the details to professionals and let the person you’re talking to keep an open menu of options. What meds worked for one person may not work for another. Meds are very personal and require direct experience to evaluate.
4) Never threaten. Unless someone is an immediate danger to themselves or others and you plan to force their arrest or hospitalization, DO NOT turn medication into a weapon for leverage. That’s a threat you may only get to make once.
5) Look at alternatives. Try to frame meds as a choice the person gets to make. “I see you’re against medications and I see you’re struggling right now. What if you had more buffer from the pain and more tools to work on what you want?” Resistance is ultimately a vote for the status quo. Don’t nudge or push but do mention realities in which their symptoms are lessened or their options multiplied.
6) Emphasize experimentation. No one who tries a medication has to stay on it without question. It would be crazy to permanently commit to an unknown remedy with no exit or ability to adjust. Taking psych meds is really a process of trial, and sometimes error. Not in the sense that the patient is a lab rat, but in the way that an artist combined colors to see what looks good together. Taking psych meds is in all ways a process of trying, evaluating, and adjusting. The patient is a critical part of this: they know how they feel, what they do or don’t like, what they can or can’t tolerate, and how their thoughts or behavior is impacted.
7) Remember the variable of time. Even the best drugs can take weeks or months to reach their full effect. Xanax may work in minutes while Risperdal takes weeks and Prozac takes months. Before you can judge if something’s working. Even then, ‘working’ depends not only on the drug but also all of the feelings and behaviors associated with taking it. That can take time to reveal. Once on a stable regimen, conditions, challenges, and chemistry may still change. A person could need more, different, or no more meds at all. Time is a key ingredient.
8) Consider side effects. If I gave you a cigarette and told you it would kill you in 40 years, you might still smoke it. If I gave you I one and told you you would gain 20 pounds, lose your energy, feel brainless, not be able to orgasm, and have constant thirst or twitching, you might not. Psych meds can have very real side effects. Don’t pretend otherwise. Do emphasize that the main effects of reducing symptoms often outweigh the drawbacks. Side effects are manageable whereas symptoms often are not. Also, side effects are data about what drugs or doses are working or need to be tweaked. Like the painter, a psych doctor is looking for the right color and the right amount of it and the right combinations in the right part of the canvas.
9) Seek effective not numb. One of the most common, and valid, objections to psych meds is that they will make you feel dulled, muted, monotone, and a shell of yourself. Emotional mobility can be excessive or problematic but people still prefer it to emotional silence. At least if a person is feeling they have a self and they are alive. If they are totally numb they might as well not be. Be sensitive to the desire to preserve self and emotion, even if a person’s sense of self is distorted or their emotions are out of control. Emphasize that the purpose of meds is not to erase a person, but to lower the volume of whatever is disturbing them and getting in the way of their genuine pursuit of happiness and improvement.
10) Minimal effective dose. Like a physical joint that is injured, the goal of taking meds is not a full-body cast where a simple sling would do just fine. Similarly with psych meds, the goal is the M.E.D.: minimum effective dose. Sometimes, in severe cases a doctor will want to strongly reign in risky behaviors so a more flattening dose might be prescribed at first for safety and to prevent relapse. That is not the goal though, and any good doctor will thereafter experiment with lowering the dose until only its necessary function is performed.
10) Start small. Unless someone is under involuntary treatment, there is often no real risk to starting on a minuscule dose and tapering up. While a person might be languishing with no meds at all, they might gain a sense of security and possibility by trying absolute minimum amount to just demonstrate that meds are not devastating or poisonous to body or spirit. Many meds are intentionally tapered up anyway, so this is often a natural part of the process.
11) Talk about burden reduction. It’s really hard being mentally ill. Not just the shame and stigma but the day-to-day experience of life can be disorienting or excruciatingly painful. Meds are a way to soothe those symptoms. They can make you feel better. They can make you able to handle life with less pain and distress.
12) Champion diversity. Every person has a unique brain. The goal of taking meds is not conformity, it’s finding the right balance for each individual. Differences are what make us interesting and often effective. It’s not a goal of meds to erase that special style or approach to life. In terms of basic neurochemistry, the goal of meds is to merely bring neurotransmitters that control feelings of safety, motivation, and self-control into line with a person’s needs and aspirations.
13) Include the whole palette. Meds are often a keystone of recovery, but remember the best treatments will always be a healthy diet, good sleep, regular exercise, time with friends, laughter and humor, exploring nature, and connecting with the breath. For some people there is a desire to go the ‘natural’ way and avoid meds. Don’t make it an either-or false dichotomy. You can take meds and also take advantage of all the tools for health and happiness. Often, taking meds it what permits a person to start using those tools again. It’s a jump-start. It’s shelter. It’s headlights on a windy road. Meds are not prison. The right meds at the right dose empower and free a person.
14) Emphasize an active role. Taking medications is just the start, and the most important person when taking meds is not the prescribing psychiatrist but the patient. When you take meds you get to, and need to, advocate for what you want. You get, and need to, report back regularly on what is working for you and what you dislike. You get to explore other options. You get to express your preferences about the direction you want to go in. You should listen to expertise, but that doesn’t mean being a passive object that the meds act on. The meds enable you to act.
15) Emphasize life benefits. Each person is on a journey. Often taking meds feels like admitting a disaster, or that a person is broken. Instead of the injury, focus on the future. Talk about the life they want, and how meds might enable them to have it. They still get to keep their memories, but they have a chance to take on the rest of their story. The most important thing a psychiatrist ever said to me is, “It’s not to late to have everything you want.” I couldn’t erase what I had been through, but taking meds was the key to unlocking the meaningful pieces that had been missing. It was not taking meds that kept them locked away from me. Meds are like a freshly sharpened pencil in the new chapter of a person’s life.