There’s a world of difference between “taking drugs” and “drugging people.” Best know which one you’re doing.





A comment of mine, cross-posted from Facebook, replying to a friend who shared a link to this article about Bipolar Disorder:

So, as a person diagnosed first with unipolar depression, then a slew of “social anxiety” labels, and finally bipolar disorder, first at the age of 12 and then continually for the rest of my young adult life, and for whom the uncritical belief in the utility of these “treatments” had disastrous, near-suicidal consequences, the information presented here strikes me as an incredibly damaging taxonomical justification for the mortal sin many humans commit called “having feelings.” I don’t mean to imply here that the taxonomic framework is useless. Obviously, naming a thing that is hurting people can begin to offer pathways to recovering from the hurt a previously unidentifiable thing has caused. What I am suggesting, however, is that this information is presented in a way that is incomplete, irresponsible, and ultimately hurtful. It is an uncritically authoritative narrative about this particular mental illness that is dangerously misleading.

The fact of the matter is that Western medicine has no theory with a shred of consistent internal logic that even approaches an explanation for what the fuck bipolar disorder even is. You can see this immediately in their taxonomy of “types” of bipolar disorder, in which they describe “type I,” “type II,” “cyclothymia,” and then the magic catch-all “unspecified.” They also have prefix modifiers, such as “atypical,” which is just psychopharmocologists’ fancy way of saying “well it SEEMS like MAYBE it’s THIS type of bipolar disorder but it’s not really matching up with all our measurements and we have no idea why so we’ll just say it’s an ATYPICAL CASE of that thing.”

Look, you don’t need to be a rocket scientist to realize that if your categorization scheme includes a “miscellaneous” category, then it’s a pretty shitty categorization scheme. And if what your shitty categorization scheme is categorizing is OTHER HUMAN BEINGS, and then you are using that categorization scheme to justify forcibly drugging children (like me), then you are a piece of shit doctor and you should die in a fire for knowingly violating the Hippocratic oath you purport to care so much about.

Now, zooming out a little bit, the “theory” Western medicine proposes to “explain” these disorders—which, if you’ll notice, have gone from non-existent to UNBELIEVABLY FUCKING WIDESPREAD in the population at the same time as the boom of the pharmaceutical industry, what a coincidence—is that people diagnosed with these disorders have “chemical imbalances” in their brains. That is to say, they either “lack” or “have too much” of one kind of neurotransmitter or another. Neurotransmitters are the physical molecules used to jump-start electrical impulses in nerve cells and hop over the gaps between nerve cells called synapses. The theory goes that certain amounts of neurotransmitters (most commonly either serotonin or dopamine or both) are required for “happiness,” and thus if there is not enough of these chemicals swishing about in the pool of chemical jelly that is your brain, you are sad.

To resolve this “problem,” Big Pharma funded the development of a whole class of drugs they term SSRIs, or Selective Serotonin Reuptake Inhibitors, which is a fancy name for “stuff that clogs up your brain cells so that they can’t absorb serotonin and thus leaves more of the serotonin floating around in your brain bath.”

Here’s the problem with the whole SSRI drug racket: it doesn’t actually work. There is literally more scientific evidence to support the idea that PLACEBOS are more effective at treating mental illness than actual chemicals. And, likewise, those actual chemicals come with a HUGE range of really terrifying side effects. To take just one extreme example, have you ever walked into the sunlight and felt like everywhere the sun was touching your skin, your skin was BURNING? Because that’s what the tiny fine print “may cause sensitivity to light” was like for me, and no one told me that until after they started noticing me hopping from tree-covered shadow to tree-covered shadow and were like, “Dude, why is maymay avoiding the sun?”

Here’s a recent take-down of the “chemical imbalance” theory that I read the other day and think is really great, sourced from The New Yorker.

TL;DR: This is some seriously abusive bullshit, more often used to justify chemically controlling people who behave in ways undesirable to authority figures like parents and schools than it is used to help people. DO NOT. BELIEVE. THEIR LIES.


I’m sorry that happened to you, and I fully agree with the whole bit about using pharma to sedate people whose behaviour is undesirable instead of trying to help people, but I’m pretty sure there is a difference between “mental health isn’t a virus and you can’t fix it with a pill, especially when applied non-consensually” and “antidepressants don’t do shit.”

You may as well suggest that nicotine or alcohol doesn’t really do anything Because Placebo Effect and Marketing. Yeah, we don’t understand the processes by which drugs affect our brains. They still clearly have an effect, and that effect should be judged on its own merits. I decided to try SSRIs because I tried MDMA and, despite years and years of cognitive-behavioural therapy-based incremental improvements, realised that I was still fucking terrified of humans when sober. Now, you can’t take MDMA on a daily basis without frying your brain, but I figured that meant serotonin manipulation might help me, so SSRIs it was. You know what? It does help. I don’t know whose idea it was to assume that “more serotonin helps” = “not enough serotonin was the problem in the first place”, that’s a fairly simple correlation v causation thing, but it still does help. I’ve made fucking leaps and bounds this year, because I’ve been able to work on my issues without the constant distortion and distraction of my fight-or-flight response kicking in at the slightest provocation. If it was legal to just take MDMA and do a few solid hours of therapy on it every month or two, I’m sure that would have had a similar effect. But we’re not toppling the legal system any time in the next couple years, so fuck it, I’m taking what I can get.

It’s completely understandable that having such awful experiences with pharma has given you a strong negative reaction to the entire concept. And yeah, bipolar diagnostics are pretty obviously fucked. But don’t throw out the baby with the bathwater – drugs aren’t the problem.

Lack of patient autonomy in the medical system is the problem. If you’ve read any of realsocialskills‘ stuff on ABA, you know people can be fucked over just as badly by non-chemical attempts to “fix them” without understanding them. Saying stuff like “antidepressants don’t do shit” is stealing focus from the real problem and incidentally potentially alienating exactly the people you’d need on your side if you wanted to pull apart the psychiatric system and put it back together in a way that’s a net positive to humanity.

“Now, you can’t take MDMA on a daily basis without frying your brain…”

FWIW, I actually have a friend who does take MDMA, at an extremely low dose, on pretty much a daily basis to manage his social anxiety and PTSD. His brain seems fine.

He’s also a psychiatric survivor who’s worked with radical community mental health care advocacy groups for years and studied pharmacology and neurobiology extensively. (And he’s a drug dealer, so he has more ready access re: self-medication than is available to most people.) TL;DR: “Don’t try this at home, kids.”

But my point is that drugs are tools. Prescription and “non-prescription” brain drugs alike have potentials both to help and to harm. But the people who are paid to “push” prescription psychiatric medication are, to my mind, significantly more malicious and less trustworthy than people who encourage the careful and conscientious use of other, arguably less harmful and side-effect-riddled substances to self-medicate. (Although, to be fair, those people often have an agenda too — especially if they’re the ones selling the drugs. So it’s always good to approach anything of this nature with caution and do a lot of research.)

Beyond that, I agree with pretty much everything you’ve said here. First and foremost, non-consensually manipulating other peoples’ brain chemistry is fucked up bullshit, no matter how you’re doing it or what substances you’re using. Anyway. I’m glad to hear you found something that works well for you. :)

I’m not sure I ever said “drugs are the problem”?

Most of you probably don’t know this about me, because Tumblr didn’t exist when I was 14 in 1996, when I started my first website, but the very first web site I ever made was about bipolar disorder. It was a blog before blogs were called blogs. It was about my diagnosis and my struggles in school, and it was the first web site about bipolar disorder to be made by a teen designed to be read by other teens on the whole Internet (which was much smaller back then).

I called this website “Ups and Downs: The Personal Story of a Bipolar Teen,” which later evolved to “Ups and Downs and Everything In Between” when I started using blogging software to blog instead of just putting reverse-chronologically ordered HTML pages up online, hence the name of my current blog, “Everything In Between”. The original site received a lot of attention, no small feat in the age before Google. Within a few years I had amassed several dozen thousands letters of correspondence and was so totally overwhelmed by the attention and my own life that I shut the whole thing down and retreated away from having a public personae on the Internet at all.

Then I re-emerged on the Internet as a public figure through a sex blog called “Maybe Maimed but Never Harmed” and the rest, as they say, is history. But I didn’t really provide this personal history just to invite you to take a stroll down memory lane with me. A lot of the writing and correspondence I had with readers of “Ups and Downs” was about medications. And some of it is still online.

Here’s a link to a personal archive I keep of that site. Peruse at your leisure. There’s a link titled “Email Pool” at the top which was something of an advice column that I didn’t maintain for long, mostly because I hate giving people advice. I just like telling them when they’re wrong about something. Click on “Medications” and you’ll find this “not really an email response, more like a short essay,” that past!me wrote in 2002:

Nobody likes medicine, but here’s the bottom line: in my opinion, if you are prescribed medication by your licensed psychiatrist you must take that medication because your life does, indeed, depend on it.

I was first prescribed medications for the treatment of bipolar disorder when I was at the tender age of twelve. Ever since then, I have hated my medication with a passion rivaling my personal beliefs and convictions. There was even a time, two years after I started taking the medicine, when I fell into a common place trap and stopped taking it because I felt like I didn’t need them; I felt “better.” Two weeks later I attempted suicide, spiraled into a pit of depression, and faced one of the darkest periods in my life. Looking back on the experience with 20/20 hindsight, I can see that I felt better because I was taking the medication.

My point in all this is that medications are a valuable tool for you to use to help make your life livable. Implicit in that belief is the assumption that you are taking the correct medicine for you, at the correct dosage. When I say “correct” I mean whatever makes you a functioning entity in your life. It took me a good full year to find the correct dosage of lithium that I am on now, and from the many people I have spoken with, my understanding is that one year is an awfully quick time. I was lucky. Patience is not just a virtue, it’s a necessity. But once you’ve found a working treatment, it’s helpful to understand these are variables in an equation designed to help you function in your life. If at any point things aren’t working, discuss altering your medications with your doctor.

Your treatment is just that — your’s, and you’ll find that it is both more effective and easier to handle emotionally if you’re the one behind the steering wheel.

This mirror’s what unquietpirate said, above, and I agree with her. And I agree with you, that it’s obvious pumping bodies full of chemicals does shit. What I’m trying to explain is that what it does is fuck shit up.

Maybe that’s something you want. Maybe those drugs are fucking shit up for you in a way that jostles you out of whatever destructive pattern you were in before long enough to grab onto a lifeline or fall into a different pit. Maybe you’re meaningfully consenting to something you know will fuck you up in some way. I’m not you. I don’t know.

But I’ll tell you what I do know:

  • I know that there is a world of difference between approaching medications the way you did, paraphrased as, “I tried MDMA once, so I figured I’d give legal SSRIs a shot” and the way I did, paraphrased as, “I hated school so they forcibly drugged me for most of my teenage life.”
  • I know that this approach alone accounts for a huge part of the differences in our experiences.
  • I know that SSRIs aren’t just legal but encouraged for children, despite the known risks and side effects, while MDMA, a drug that is in its purest form essentially the same drug concentrated so it actually has a marked (and temporary) effect is illegal to make, use, possess, sell, and so on, and only very recently are people even beginning to question why that might be.
  • I know that drug classifications are political bullshit because SSRIs are handed out like candy by teachers and doctors while MDMA is criminalized to the point of sending police on no-knock, unconstitutional raids in efforts to cage, shoot, and kill people, usually poor people and Black and Brown people, and especially poor Black people.

So I take it very personally when you say that dissing antidepressants is like “throwing out the baby with the bathwater.” There is no baby here and the bathwater is actually Drano. “Taking drugs” is one thing. But that’s not what we’re talking about. We’re talking about drugging people.

By way of analogy, hammers can be used to kill people. I wouldn’t suggest someone who wants to put a nail into a wall not use a hammer. But I also wouldn’t suggest that someone who picks up a hammer to put a nail in the wall is doing the same thing or even using the same kind of object as someone who picks up a hammer to kill someone with. One’s a carpentry tool and the other is a weapon, even though they’re the same hammer.

Finally, I think it’s worth explicitly pointing to two points cognitivedefusion made in the piece I linked in the original post where they respond to a defense of antidepressants:

2) “In fact, since there is no theory to replace it as of yet, continuing to use and refine drug therapies is probably the best option.” – Why? Why is it best to continue refining therapies which are inferior to other working treatments? When you look at the long-term data, behavioral treatments surpass medicinal treatments. This has been verified in anxiety, depression, even ADHD, which many people assume requires pharmacotherapy.

3) Interestingly much of the dysfunction associated with psychosis stems from the persistent attempts to reduce said symptoms. This finding is transdiagnostic, in that all distress from mental illness stems at least partly from attempts to avoid or escape. Teaching functionality at an earlier place in time (i.e., during prodromal phase) yields better outcomes than trying to reduce symptomatology. And interestingly, antipsychotics are not found to be too effective either. They reduce some positive symptoms (sometimes), but do nothing for negative symptoms, and will bring on some of their own symptoms as well. It’s really not a particularly sound treatment when looking at the data.

So that being said, I don’t think our opinions are actually that different. But I’m not going to entertain the idea that antidepressants are in any way a reasonable, safe, or even preferable first, second, or third resort for people suffering with bipolar disorder. If someone can acquire and use it safely, and if they have the appropriate social support structures to self-medicate with it (a thing that most people who are seeing doctors are actually trying to seek but have to pay for Because Capitalism Destroys Relationships) I would suggest illegal MDMA before I would suggest seeing a clinical psychopharmacologist.

That is, unless someone is in a situation so dire that they are already trapped inside of the medical industrial complex for one reason or another, like I was because I was not an emancipated child and I was going to school, so I had no legal power of my own. Similarly, I would never suggest someone seek the “help” of a lawyer unless they were in such dire straights that they were already ensnared by the legal system. Eschewing antidepressants and prescriptions for such versus mindfully self-medicating just seem like such vastly different spheres of concern to me that the distinctions between them seemed obvious.

I hope this makes my position more clear.