Medication and Stigma

Why are some illnesses and conditions stigmatized while others are not?  Writing in the New York Times, Dr. Aaron Carroll, chief health officer of Indiana University, suggests that stigma arises when we don’t understand the causes of a condition.  Mental disorders like bipolar and supposedly “lifestyle” problems like obesity and alcoholism may appear to be more under the control of the sufferer than they really are.  So, we blame people for a lack of willpower, instead of looking to the more complex causes that underlie what we see on the surface.

Carroll notes that this stigma-causing misunderstanding also extends to the medications, such as SSRI’s (selective serotonin reuptake inhibitors), that are widely used for depression.  Since scientists are not sure why serotonin works in the brain, or why SSRI’s work for some and not for others, people seem to believe that their effects are not “real”.  However, many people derive real benefit from taking these medications.  It should not be seen as a failure on the part of people who feel better and function better when taking medication.

Describing his own personal journey, Carroll describes how he spent years trying to treat his depression and anxiety with counseling, but finally suffered such a severe panic attack that he felt forced to try medication.  The results, he said, were “remarkable” and all the people around him noticed the great improvement in his mood and social functioning.  On reflection, he says that, although he knows it isn’t true, he felt like it was “cheating” to use medication to manage his illness.

Carroll goes on to describe a similar experience with the newer drugs now being used for obesity.  After struggling with his weight for most of his life, his first experience with obesity medication was similarly revolutionary of his life and health.  He notes the concerns of “thoughtful” people who argue that medication shouldn’t be used because “people often regain the weight if they stop taking them,” to which he replies “of course they do”.  The medication is doing something to support health, and if the medication is stopped, the support is no longer there.  The condition (whether we understand it or not) will continue.

The overall conclusion here is that we do not need shame or stigma.  They serve no purpose, whether we impose them on ourselves, or they are imposed from outside.  If medication works to improve a person’s health there is no shame in using it.

– Nancy