Dear Therapist:
I’m on medication (citolophram) for minor depression, so minor that I “lived” for 20 years with it always wanting to go for help, but never being desperate. My parents put me on meds with the guidance of a qualified top psychiatrist although I was going into shidduchim. It wasn’t even a discussion; medication was the best option for me along with regular therapy and that’s what we did. I could have stayed away from medication and managed somehow, but now that it’s been a year since I’m on it, I would never turn back. I just want to clarify that I seem so normal to everyone. I am popular, outgoing, smart and people who don’t know what I go through would assume that I live a perfect life. I’m just deeper and more emotional than others which caused me to experience depression but otherwise I had no reason to attach the mental health stigma to myself, but I did either way. I myself had requested to go get help; no one believed what I was even going through. I know it will affect my shidduchim, but I don’t care, and if only boys with similar backgrounds would consider me, I wouldn’t mind since my struggle has strengthened me and I’d assume likewise for him. My friend has anxiety which is more severe relative to my depression. She had spoken to a referral agency and with a private referral expert and they both told her to avoid medication and first investigate all other options. My friend is suffering very much and going for therapy is not helping her in the short run. What I don’t understand is the stigma mental health professionals are having towards medication. I feel from my experience that I needed the medication to take the edge off the pain and only then could I work on all the underlying issues that were causing the depression. I feel that for many people, working on themselves while they are in so much pain is highly impossible. The medication that I take has no side effects and is so helpful in giving me the head start to make real changes. Also, if mental health issues cause an imbalance in a person, even a slight one, wouldn’t it be way more beneficial, or maybe the solution, to first go on medication and then work on all the problems?
Response:
My initial reaction upon reading about your experiences and your question was: “There is nothing more for me to say.” You very eloquently expressed my beliefs and touched on issues that I often attempt to publicize. The mental health stigma—and that related to psychiatric medication in particular—is one that has lingered. This is despite changes in society and in the proliferation of mental health education.
Although the stigma of mental health treatment continues to subside over time, it seems to take more time for this to occur in certain populations. The frum community has made great strides in this area over the past few decades, but more work is needed.
Your experience is very far from unique. You are one of the brave ones who chose to better your life—but you believe that you will be punished for this. There are many people who have “managed somehow” without medication, but who can lead much happier and more fulfilled lives with the help of medication. They often feel that they are between a rock and a hard place. They may desperately want to feel better, but they equally strongly want to find the best possible shidduch. This is a terrible position in which for someone to be placed.
The irony is that many of those in this position continue to buy into the idea that they need to find the “perfect” match. This typically means someone who, on the surface, appears to have no issues. Naturally, we all have issues. When the system strongly discourages use of medication, the likelihood of marrying someone who require medication (but is not taking any) increases. This can lead to marital issues, unless and until they recognize the need and break through the stigma.
There are many reasons for the creation and perpetuation of a stigma. These range from lack of knowledge and understanding to the emotional need to separate people into classes (often to boost one’s own ego). Once a stigma is created, it tends to become self-perpetuating. With regard to the mental health stigma, we can identify a reciprocal relationship between preconceived notions and the status quo. As long as people believe ideas like only “damaged” people need psychiatric medication, people will be reluctant to take such medication. Therefore, for the most part only those in dire straits agree to be medicated. This reinforces the notion that these medications are only for highly troubled individuals. Further reinforcing this notion is the fact that those people who buck the trend—and do take medication despite being “okay”—often hide the fact.
I applaud you for doing your part to let people know that psychiatric medication can be extremely useful for the average, “popular, outgoing, smart” person who seems to “live a perfect life.” Hopefully others in similar situations will take your words to heart. Hopefully the community at large—and the shidduch community in particular—will take notice.
-Yehuda Lieberman, LCSW
psychotherapist in private practice
Brooklyn, NY
author of Self-Esteem: A Primer
www.ylcsw.com / 718-258-5317
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