side effects

therapy is better without true believers



Anonymous said to realsocialskills:

I was wondering if you/ any of your followers have thoughts on mindfulness as a treatment for anxiety? It seems to be recommended by a lot of doctors where I live as something that always works and has no side effects.

realsocialskills said:

It sounds like you’re encountering a lot of true believers.

“Always works and has no side effects” is not true of anything. That’s true believer talk; someone who is giving you medical advice ought to be giving you a more nuanced view of your options and the potential risks and benefits involved. If you can, it’s worth putting in effort to get a doctor who is willing to proactively take a frank and nuanced approach to treatment decisions. (Some doctors start acting that way if you ask them enough good questions. Some don’t. Finding good doctors who take your insurance can sometimes be hard.).

Mindfulness is one legitimate approach to managing anxiety that works very well for some people. It doesn’t work for everyone, and it’s not the only legitimate approach. I don’t have any way of knowing whether it’s something that you should try. (Both because I don’t know you and because I’m not an expert on helping people make that kind of decision.)

There are approaches other than mindfulness that some people find helpful. Eg: CBT, various types of medication, general psychodynamic therapy, art therapy, or working to accommodate sensory issues better so that you have less background stress. No approach is universally effective; no approach is universally safe. They all work to a significant extent for a significant percentage of people. They all also have risks and drawbacks.

Nothing is 100% effective, ever. No treatment or approach works consistently for everyone. People are complicated, and many things about the brain and body are still not well-understood. For many issues, there are wide ranges of legitimate and possibility-legitimate approaches. Trustworthy doctors and therapists are honest about this.

Further, everything that is powerful enough to have good effects is powerful enough to have side effects. Some people have this weird misconception that if something doesn’t involve medication or surgery, then there are somehow no risks. In reality, there is no risk-free approach to improving the way your mind and body are functioning. Anything that’s powerful enough to cause good changes runs the risk of causing bad changes. (The risk is not always high, and even high risks are often worth taking.)

Does anyone want to weigh in with experiences with mindfulness? What are some things you wish you’d known, or that you think it would be helpful for the person who asked about this to know?

tl;dr Mental (and often physical) healthcare decisions are complicated. Some approaches work amazingly well for some people. No approach is effective for everyone. Every approach has risks and drawbacks. If you are seeking professional help, it’s worth looking for someone who is realistic and honest about likely outcomes, potential risks, and the range of treatment options.

lizardywizard said:

I’ve definitely heard people talk about mindfulness as having negative side effects, sometimes intense ones. This article, and the things it links to, might be a good place to start.

That’s not to say that mindfulness is bad or that we should avoid practising it - just that, as realsocialskills says, anything that’s powerful enough to cause good changes runs the risk of causing bad changes. This definitely seems to be true of mindfulness.

"You're just looking for a quick fix"







If you use medication to make your life easier or better in any way, some people might object, and say “you’re just looking for a quick fix!”.

This is a mean and unhelpful thing to say.

Medication isn’t the right answer for everyone who has cognitive or mental health problems or pain or other reasons people take medication, but it can be game changing for some people. If you try medication and find that it makes your life easier, that’s a good thing, and it’s ok to be happy about it.

It’s ok to want your life to be easier. It’s ok if it turns out that there’s something that works quickly that makes things better. Using an effective strategy to make your life better isn’t being lazy; it’s being efficient.

bluebirdofgrumpiness said:

Setting aside the fact that working out the correct medication and dosage is often anything but quick, it irks me when people condemn the desire for mental illness to be treated as quickly and painlessly as possible as some kind of moral failing. 

If you have pneumonia or a broken leg, do you request the slowest, most character building treatment available? No? I didn’t fucking think so.

realsocialskills said:

Actually, this happens to people with chronic illnesses a lot too, particularly if they are also fat and in pain.

People often pressure them into treating everything with diet and exercise, even if that’s not an effective treatment. And people who want actually effective treatments for physical conditions are often told that they’re just looking for quick fixes.

It doesn’t happen so much when people without disabilities or chronic conditions need treatment for an acute issue, because those people are socially valued and not blamed for their conditions.

confide—nemini said:

I don’t shame anyone for taking medication and I do believe that it is right in many circumstances. But, as someone who suffered from massive health problems from taking medication and as someone who knows about all the corruption between doctors and the pharmaceutical industry, I have some massive reservations. Just watch John Oliver’s “Last Week Tonight” episode on drug reps. One of the medications I was on is featured during the segment.

One medication made me lose 50 lbs and I was NOT overweight to begin with. I was skin and bones until I stopped taking it. Other medications made me sleep at least 12 hours everyday, making classwork and attendance almost impossible. I did not have this problem after I stopped.

I know fuckyeahlimerence suffered from similar problems though our views on the subject aren’t exactly the same. 

Message me if you want to know more.

realsocialskills said:

I am not familiar with that episode, so I can’t comment on that specifically.

I agree with you that there is a massive issue with lack of regard for the physical risks of psychiatric medications, particularly neuroleptics. (Especially when they are prescribed to control aggression or psychosis.)

Doctors often do not inform people of physical risks in any meaningful way, and often are dismissive of people who want help deciding whether or not the risks are worth the benefits. Further, when people who take psychiatric medications express concerns about side effects they’re experiencing, this is often treated as a symptom of mental illness to be addressed through counseling or a higher dose, rather than a physical symptom needing physical attention.

And it’s not at all uncommon for people to be prescribed medication that is flat-out inappropriate for their actual circumstances. (Eg: It’s fairly common for women to be misdiagnosed as depressed and prescribed SSRIs; it’s fairly common for autistic people who are aggressive during puberty to be prescribed neuroleptics to control their behavior.)

All of that is a huge problem. Medication is important for a lot of people, and so is avoiding inappropriate or harmful medication. Generally speaking, access to respectful, consensual and medically responsible mental health care needs to be far, far more widespread than it is. Far too many people only have access to needlessly dangerous care, often against their will. That’s as much of a problem for people who should take medication as it is for people who shouldn’t take medication.

I don’t want to be dismissive of any of that. Stigma is by no means the only important problem facing people who take psychiatric medications. 

squidids said:

The thing is, every single thing that has effects, has side effects. Literally every kind of thing, not just medication but also herbal stuff, and yes, even diet and exercise changes. Even meditation. If it is capable of doing a real thing to your body, then it is highly likely that it will also do other things to your body. I’d also even argue that lifestyle effects - such as cost, loss of time to do other things, or whatever - can also be just as side-effect-y as other physical effects like dry mouth or weight gain/loss.

It’s good to be aware of the side effects and to know one’s alternative options. And yes, when doctors have perverse incentives, then sometimes that can be hard. 

realsocialskills said:

Yes, exactly. Everything that has effects also has side effects. Those side effects matter. Sometimes they’re dealbreaking; sometimes they’re not, but they always matter.

It can be particularly hard to make good decisions when you’re surrounded by people who have some rigid ideology or other about medication. It’s hard when you’re surrounded by people who try to convince you that medication is bad and that no side effects are worth it at all, ever. It’s also bad when you’re surrounded by people who try to convince you that any medication a psychiatrist might want to prescribe is just like insulin for a diabetic and that there can be no valid question about whether it’s a good idea to take it. 

Decisions about psychiatric medication are complicated and personal. (That’s generally true for physical health treatments as well.) It’s important to acknowledge that reality in both directions.