Claudia M Gold M.D.

Child in Mind

Why Is Antidepressant Withdrawal a Hot Button Issue?

Are the extreme reactions to its identification really about something else?

Posted Apr 10, 2018

The recent New York Times article addressing difficulties with withdrawal from antidepressant medication drew an impressive over 1,000 comments in its first 48 hours following publication. Clearly author Benedict Carey has touched a nerve. People appear outraged, some calling the piece “dangerous” and “irresponsible.” Many share their own personal stories of how the pills have helped them, and how they had no trouble getting off the medication. Many accuse the author of shaming individuals who have an illness no different from diabetes. This outrage comes through powerfully, despite the fact that the following statement appears prominently towards the beginning of the article:

The drugs have helped millions of people ease depression and anxiety, and are widely regarded as milestones in psychiatric treatment. Many, perhaps most, people stop the medications without significant trouble.

Reading this "conversation" brought to mind the original title of my first book, "Its Not About the Soup." (I nixed it in favor of Keeping Your Child in Mind but it remains the title of the first chapter.) The phrase refers to a boy having a meltdown about dinner when it’s really about his distress around his mother's emotional unavailability and a whole complex array of other experiences. Yet he and his mother becomes focused on the dinner choice, allowing them to avoid dealing with the bigger underlying problems.

So what might the conversation really be about? Why is this idea of withdrawal syndrome so profoundly unsettling? Maybe its not about the pill. I wonder if the pill, while itself useful in alleviating distress, represents a cultural construct of "mental illness" that is flawed and in need of change. Such a recognition might be deeply unsettling to both practitioners and recipients of mental health care. 

The article references The Withdrawal Project, a grassroots community effort of the Inner Compass Initiative that provides resources on psychiatric drug withdrawal, including a guide to tapering off. It quotes my friend Laura Delano, who recently founded the Inner Compass Initiative. 

Laura and I met online about 4 years ago. On my blog I was writing about children whose voices were being silenced by our society's rush to diagnose and medicate; these blogs together became my second book The Silenced Child. Laura, who was writing about her experience in the mental healthcare system for her own blog, reached out to me after reading my work.

Laura is in a sense that "Silenced Child," but now an extraordinary adult, who has through her own strength and resilience,  found her voice. She was diagnosed with a major psychiatric disorder as a child, experienced a downward spiral as she fell deeper and deeper into the mental healthcare system until finally, due to her own "inner compass" she emerged to begin this journey she is now on to change the way we as a culture understand mental health and mental illness.  

I agree with Laura that we need to question the whole construct of mental health "disorders."  These represent not known biological constructs but categories of behaviors or "symptoms" that have become reified by the DSM system, often referred to as the "bible of psychiatry," and mainstream mental healthcare.  For example, it is a fallacy that depression is a disease no different from diabetes. In his tome on depression, The Noonday Demon, Andrew Solomon articulates this idea beautifully. He writes:

Although depression is described by the popular press and the pharmaceutical industry as though it were a single effect illness such as diabetes, it is not. Indeed, it is strikingly dissimilar to diabetes. Diabetics produce insufficient insulin, and diabetes is treated by increasing and stabilizing insulin in the bloodstream. Depression is not the consequence of a reduced level of anything we can now measure . . . “I’m depressed but it’s just chemical” is a sentence equivalent to “I’m murderous but it’s just chemical” or “I’m intelligent but it’s just chemical.” Everything about a person is just chemical if one wants to think in those terms . . . The sun shines brightly and that’s just chemical too, and its chemical that rocks are hard, and that the sea is salt, and that certain springtime afternoons carry in their gentle breezes a quality of nostalgia that stir the heart to longings and imaginings kept dormant by the snows of a long winter. 

A different model from that offered by mainstream psychiatry, one that is rooted in developmental research, is in order if we are to get off this path of ever increasing numbers of both children and adults diagnosed with mental illness and medicated.

Developmental psychologist Ed Tronick, who developed the Still Face Paradigm, offers such a model.  Decades of research with infants and parents reveal that the same developmental process underlies both  "normal" and "pathological" development. Both emerge out of the iterative moment-to-moment interactions in relationships, beginning with our earliest caregiving relationships. These ways of being are not “baked in the cake.” We continue to change and grow by immersing ourselves in relationships that move us in a healthy direction. 

Laura Delano is setting out to do just that with the Inner Compass Initiative. Far beyond much needed support for withdrawal from antidepressants, she is helping to change the nature and direction of the conversation.

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