Is shaming the 'pill-shamers' shutting down debate?

Leigh Emery

‘Whatever is begun in anger ends in shame.’- Benjamin Franklin

Keep taking the tablets. But
maybe keep quiet about it?

Over the past year I've immersed myself in Twitter. Like many I started tentatively, following the usual parade of news sites and comedians. It didn't take long though to realise the value of Twitter for discussing mental health. It’s packed to the rafters with campaigners, professionals and service-users. It’s also, famously, a place where people feel free to say more or less whatever they want. Put all these elements together and the result is a powerful (if dissonant) mix of voices in social media and in mental health.

Recently, some Twitter followers have turned their attention to several articles in the national press which critique the use of psychiatric medication. These articles, one by novelist Will Self, another by commentator Giles Fraser and a third by psychiatrist Joanna Moncrieff, broadly say the same thing: life’s ups and downs are being pathologised and psychiatric drugs are being wildly overused.

These articles angered many and the dissonance on Twitter quickly built up steam. Besides the authors being accused of rehashing clichéd arguments, they were also chastised for trivialising the experience of living with a mental health problem. Above all though, they were criticised for implying that people who take psychiatric medication are weak, stupid or being duped by the pharmaceutical industry. A new phrase (with accompanying Twitter hashtag), ‘Pill shaming’, was coined to describe media articles that make people feel that taking their medication is wrong.

‘Pill shaming’ is an emotive term and one, I think, that may be hard to challenge. It’s grounded in the idea that, for some, medication is the only thing that can make day-to-day life tolerable. That medication can, literally, be the difference between life and death. To be told that such medication is simply part of an elaborate con devised to make money for pharmaceutical companies may be seen as unhelpful at best; and at worst, insulting.

I wonder, though, if the accusation of insulting or shaming tells the whole story. While it’s true that medication is not optional for many people with severe mental health problems, there are also people who perhaps do have some choice and who should be questioning whether medication is the right option for them. Medication comes with some nasty side-effects and is not always the best solution for everybody. There are people who, for example, are given antidepressants when bereavement counselling, therapy or self-help groups might be more helpful. Others might find that lifestyle and diet changes are enough to make them feel better. Is it shaming to suggest this?

The three articles that sparked this debate perhaps make some poor choices of language. The tone of Giles Fraser’s article seems to play down the burden of living with depression, and readers of Joanna Moncrieff’s article may feel alienated by phrasing such as ‘zombie’ pills and ‘the newly fashionable diagnosis of bipolar disorder’. However, the articles also make some important points that seem to have got lost in the Twitter storm.

Giles Fraser’s piece raises concerns that social and economic factors that affect wellbeing are overlooked. This is a completely legitimate point. We probably should be wondering why, for example, prescribing for ADHD medication is rising steadily or about the reasons Afro-Carribean men are more likely than other groups to be diagnosed with a severe mental health problem. Perhaps there are other avenues of help to be explored?

Will Self’s article reminds us that the criteria for mental health diagnosis often emerge based on the conventions of the time (famously, homosexuality was a mental health diagnosis until 1973). This doesn’t mean to say that the suffering associated with psychological distress is not real, but that perhaps the way we talk about mental health can be unhelpful. This has links with the recent call by the British Psychological Society for a paradigm shift in how we understand distress.

Joanna Moncrieff argues that the evidence base for psychiatric medication may be misrepresented and that the way that medication is ‘sold’ to us may be misleading. We are, for instance, told that antipsychotic medication targets the ‘psychotic’ elements of the brain chemistry when perhaps it would be more honest to think of it in terms of a more general sedation, one of the effects of which is to tone down the impact of so-called psychotic experiences.

The questions these writers raise are worth asking, even if the way they might be asked offends some. I do worry, though, that strong reactions to critiques of psychiatric medication shut down important debates before they’ve begun.  Of course, people shouldn’t be made to feel ashamed to take medication to cope with psychological distress. And of course, there is a right to call people out if they feel that this is happening. But maybe it’s counterproductive to bring the full force of Twitter down on anyone who criticises the use of psychiatric medication. That too is shaming.

We are aware that this issue has prompted many strong views. We would therefore be very interested in your opinions in the comments thread below. Leigh has agreed to be available to comment and respond over the next few days. You can follow Leigh on Twitter @SafeUncertainty. (Eds.)