On World Mental Health Day 2019, a look at how ignorance leads to pill-shaming and disempowers individuals
The idea behind putting an end to pill-shaming is to support the individual’s right to take care of themselves using means that are valid, reliable and universal
The age-old view of psychological distress as an isolated external influence seems to have translated into current times in the form of pill-shaming
People also pill-shame others because of internalised misconceptions and ignorance
The idea behind putting an end to pill-shaming is to support the right to take care of oneself using means that are valid, reliable and universal
“Medicine is only for the weak.”
“You can’t stay on it for your entire life; you need to get a grip on yourself.”
“Have you tried Yoga?”
After having been prescribed psychiatric medication all of once, 25-year-old Anannya was at the receiving end of such remarks from friends and family, which only made it more difficult for her to manage the very distress the medication was prescribed for. Pill-shaming, one of the many by-products that has emerged from generations of stigmatising mental health, is rapidly growing in India.
It wasn’t until the 80s that the concepts of shame and humiliation were officially discussed in the field of medicine as legitimate factors that prevent people from seeking care for a variety of physical and mental ailments. Pill-shaming, although experienced universally, is dominant in mental healthcare.
The age-old view of psychological distress as an isolated external influence seems to have translated into current times in the form of pill-shaming, where taking medicine for it is considered unreasonable.
As a result, the person falls victim to passive prejudice; they are viewed as weak, irrational and dependent.
“I’ve been prescribed medicine for depression, panic attacks and sleep-related issues. People as close as my parents would constantly ask me to stop medication and wonder why I need them in the first place. I remember my father telling me to improve my sleep routine instead of wasting money on medicine. Some people would express pity, as if it is hard to imagine me working without them,” Anannya says of her experience.
Anannya noticed a pattern in the reactions, which stemmed from an idealised image of the body and mind. “It’s like if I am strong enough, I shouldn’t be needing medication, and if I do need them, I’m not strong enough to face the world," she added.
It’s clear from her plight and that of many others that such forms of prejudice stem from an inability to accept mental health’s association with the human brain. Therefore, to tackle pill-shaming, it is crucial to understand the vital role of medicine in dealing with mental health issues, since most people engaging in pill-shaming do not know how medication works when it enters the system.
How does a psychiatric pill work?
Apparently, the term “chemical locha” coined in the film Lage Raho Munna Bhai isn’t a misnomer. Our nervous system harbours several chemicals known as neurotransmitters that facilitate our physical and behavioural expressions. Want to move your arm? A chemical known as acetylcholine will inform the muscles about your decision. Are you feeling joy because you accomplished something? Neurotransmitter dopamine is at work, helping you feel that joy. Had a glass of wine? To help you achieve that “floating” feeling, the chemical gamma-aminobutyric acid (also known as GABA) will slow down some neural functions, so you can “relax”.
The same neurotransmitters are responsible for our psychological functioning. Serotonin is responsible for feeling happy, content and worthy. It also makes sure we sleep on time, eat well and experience pleasure. All these chemicals are released through the end of each neuron (known as terminal buttons) and are accepted by the next neuron’s receiving end (known as receptors), and so on, until the task is done. Imagine this like a chain of locks which get opened when the right key (chemical) fits into the right lock (receptor).
The science is simple: when a person suffers from a mental health issue, either due to a biological or a psychosocial cause, it disturbs the work of these keys, creating a disturbance in this chaining and the behavioural disturbance we see outside is only a result of this disturbance. Sometimes it shuts down the chemical supply; at other times it fails to put a stop when needed. So what does the medicine do here?
Let’s take Anannya’s example. For depression, Anannya takes a tablet known as Paroxetine, which is a Selective Serotonin Reuptake Inhibitor (SSRI). Serotonin levels in Anannya’s brain seem to be lower because the neurons that are supposed to release this happy chemical are instead pulling it back, hence causing wastage. When she takes Paroxetine, the salt enters this dysfunctional site and makes sure the chemical isn’t pulled back but released into the next cell properly. Anannya also takes Etizolam, which steers the levels of GABA that shut down the heightened neural activities in her body and calm her during a full-blown anxiety attack.
These medicines are akin to copied keys of the original ones present in our brain, that either open or close the required locks. As a result of these medicines, Anannya sleeps well, engages in things that make her happy and is functional enough to work with her problems. “And yet making such a choice is frowned upon and I’m seen as weak for making it,” Anannya says. Instead of “dependency” or “weakness”, this is nothing but necessary self-care that needs to be encouraged rather than shamed.
Factors shaping pill-shaming culture
Dr Anjendra Targe, a practicing psychiatrist based out of Pune, weighed in on the conceptualisation of pill-shaming. "It’s a socio-cultural phenomenon arising out of ignorance, lack of information and a ‘natural-over-artificial’ mentality, despite the fact that medicines are evidence-based and save millions of lives,” he explains. People pill-shame others because of internalised misconceptions and ignorance, something that Dr Targe observes in his practice everyday. “Much of my energy in most consultations is spent on dispelling myths and misconceptions about medicines people bring with them.”
Therapy has similar effects on the brain, but any good mental health professional, in times of severe impairments, prefers an inclusive approach that takes into consideration medication and therapy. “When conditions turn severe, therapy doesn’t seem to work because the underlying symptoms haven’t been treated and this is where medication is useful. That is a reason why many people drop out of therapy, thinking it’s not effective,” Dr Targe adds.
A large section of the Indian population suffering from mental distress seeks medication, as observed in every public hospital’s psychiatric OPD. This includes people from socio-economically oppressed backgrounds, some even coming from remote areas. And yet pill-shaming persists, suggesting a class difference in the people who perpetuate it. Dr Targe notes this difference, “In my practice, it is mostly the middle and upper strata from whom I face a lot of resistance to medication, whereas patients from peripheral and rural areas are much more amenable to and welcoming of the treatment.” He attributes the former group’s resistance to biased information people attain from the internet or through friends/family about the “ill effects” of psychiatric medicine, as well as the culture-specific imposition of “natural” methods.
The many myths surrounding psychiatric medication, often expressed in pill-shaming, include the tendency to get addicted, fear of bizarre side-effects, decrease in sexual desire etc. and have been debunked numerous times. But the unhealthy spread of these myths is tenacious. Dr Targe ascribes this to the faulty healthcare system in India. “A poorly-regulated, unstructured and unscientific healthcare scenario has led to a tremendous surge in quackery and unqualified medical practitioners. I’m not surprised to find that sometimes it is the family physician who advises against taking psychiatric medicines.”
The tendency to inflict judgment on someone for taking medication for mental health doesn’t seem to hold any plausible ground and only persists out of sheer ignorance. The idea behind putting an end to pill-shaming and supporting medication is not to endorse one method of treatment over another or to increase the profits of the pharmaceutical industry. It is to support the individual’s right to take care of themselves using means that are valid, reliable and universal.
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