The Devil You Know

Part 2 in a series on medicine and the thought processes that go into deciding to take it. Read part one here.

Before I start this post I need to stress: I have no training scientific or medical and I cannot stress enough how important it is to consult with a doctor before making any decisions about medicine or treatment. End disclaimer.

In the year this blog lay dormant, I thought a lot about medicine for mental illness. I have seen my friends-- and, frankly, myself--struggle with a bevvy of diagnosed and undiagnosed problems and then struggle with the question of whether or not to take medicine.

What is it about taking medicine for mental illness that makes people balk? We take medicine for all sorts of things. For allergies, for colds, for muscle aches, for cramps, there's a pill for every ailment and we take them and praise modern medicine.

And then, we face mental illness. For many mental illnesses or disorders there are even physical symptoms. I don't think there are any direct physical manifestations of ADD, but the possibility of anxiety that comes with unchecked ADD certainly has physical effects, as does depression, which also can stem from unchecked ADD.

But its not the physical symptoms--of any mental illness--or not only the physical symptoms. Emotionally and mentally, medicine can be life changing and, in some cases, life saving.

Why the fear? Why the worry about taking medicine that can change a chemical makeup on the brain? That can address the biological basis of something as confusing and often as intangible as mental illness and disorders?

I don't have all the answers. I wouldn't even presume to have a single fully formed answer, and I can't speak for other people's fears; this is a question that plagues even some of the most accomplished psychiatrists and psychologists. But I've been thinking about it a lot and I have a theory.

I think that this idea works best when applied to adult mental disorders, which is the focus of this blog. I think it is particularly applicable to ADD, because unlike some other disorders that are treatable with medicine, ADD is something that doesn't just show up. You might get diagnosed later in life, but once you're diagnosed, you know that you've had it for a while.

Not to resort to cliches, but I think that the question of treating adult ADD is a question of the devil you know versus the devil you don't. Someone who gets an ADD diagnosis in adulthood had already found some coping mechanisms. Even though the coping mechanisms likely will have failed enough to start thinking about treatment in the first place, ADD is the way that you have lived . However effective or ineffective those coping mechanisms were the whole package of struggle and coping become part of your personality; you know what it feels like, you know what it looks like.

Medicine, however, is not known. Additionally, it's the failures of medicine that get more attention that success. Breakthrough technology gets coverage, but the day to day stories of people taking pills and feeling better are not news, are not talked about, and are not fretted about. A brief look at just some of the articles that have caught my attention, indicate how scary the Internet can be when you are looking for guidance.

In recent weeks the Supreme Court ruled that patients could directly sue drug companies, which then lead up to several other cases, where people who committed suicide while taking different antidepressants. It's in the news, and its frightening.

And then, there was a mystery diagnosis that the New York Times Magazine printed which featured some scary stuff about Concerta, one of the ADD meds. (That article, I think deserves its own, nuanced blog post, because Concerta is safe and was used in an extremely unusual situation that became unsafe). And there is news of over-diagnosis and over-medication. And then, this article about Paxil resurfaced on Slate. I suspect that it resurfaced because of the renewed interest in the legal ramifications of misusing, or mis-prescribing drugs, and because of the settlement of a case regarding poorly-made pills.

So there's the news, and the fear that the medicine will change your personality (whether that's the coping mechanisms or something larger), and the fact that at the end of the day, the only way you can tell if medicine is working out is by trying it and seeing how you feel. That trial and error process can be both scary and frustrating. And then there's the stigma, which to be perfectly honest should be lifted, but its not. It's still going strong, which is why this blog was anonymous.

So then you choose.

The devil you know: ADD and everything that comes with it: all the crap that comes with it, all the personality quirks that might be part of it, and all the coping mechanisms that you've sorted out over the years.

And then the devil you don't: medicine, all its uncertainty, and all the frightening stories that float around.

It's hard to get past that fog and see the positives, the possible assets among all the uncertainties.

That's one theory at least.