Dr. Julie Holland, a New York psychiatrist, recently penned an article for The New York Times entitled “Medicating Women’s Feelings“. In it she discusses her feelings about the abundance of psychiatric medicines that appear to be prescribed for women to medicate what are perfectly normal emotions and responses to situations. She describes a situation where one of her clients called her to ask for an increase in the dosage of her antidepressant medication. When the client was asked about her reasons for wanting an increase, she detailed a situation where her boss had openly humiliated her at work which led to her being in tears in the office. Dr. Holland suggested, and I agree, that more medication was not the answer in this case but having a conversation about this event with her boss was likely a much better solution. While reading the article, I found myself agreeing with many of the points made. Similar to Dr. Holland, I believe that there is a tendency in our society to overmedicate and undervalue the importance of paying attention to more organic ways of improving our mental health (i.e. developing healthier coping strategies, learning to be more assertive, setting healthy boundaries, etc). I also agree that women are often unduly penalized for having more emotional expressions and that instead of focusing on how we can squelch these emotions, we should be focused on teaching everyone how to pay attention to emotions and what they may signal about our life and our mental health. However, I also found myself thinking that for many of my clients, 95% of whom are Black women, the concerns presented in this article would never be an issue, because so many of them are reluctant to try psychiatric medications, even when they seem warranted.
I have worked in a variety of settings, with a variety of different populations, with all types of presenting issues, and it remains that my Black women clients are the most opposed to being referred to a psychiatrist. I believe that a large part of this sentiment is directly related to the stigma regarding receiving mental health treatment. Even though they have already taken the first step to talk to a therapist, there seems to be this idea that if I need medication, ” I must really be crazy.” Because of these concerns, I tend to be pretty conservative when even suggesting a psychiatric referral. I believe that many clients can work through their issues in therapy alone, but I also believe that for many clients, the work cannot be started if they are not in a clear place. For example, if you are experiencing a significant depressive episode where you are having difficulty getting out of bed in the morning, experiencing decreased motivation and frequent suicidal thoughts, you will be less likely to participate in some of the things I may suggest to help you to feel better simply because you do not have the energy to do so. However, if you started on an antidepressant as prescribed by a psychiatrist, in a few weeks, you are likely to have more energy and may be better able to focus and participate in some of the activities (i.e. engaging your support system, exercising more) that may actually help to further alleviate the depressive symptoms. Of course medication is not the right choice for everyone, but given that many who use psychiatric meds do experience some benefit, why then are Black women still so reluctant to try? Some of these reasons include:
A lack of African American providers- It is estimated that only 2% of all the psychiatrists in the U.S. are African American. Given the large propensity for Black women to seek helping professionals who look like them, this may be a huge deterrent for seeking psychiatric services.
Self medicating with other substances- It may not feel necessary for some women to try meds because they are already self medicating with other substances. Have you ever felt the need to sip on a few glasses of wine to “calm your nerves” before bed? Many Black women are using substances like alcohol, marijuana, and nicotine to manage depression and anxiety instead of talking with a psychiatrist. And while they may not be considered substances, using sex and shopping to numb and dull feelings falls into this category as well.
Distrust of medical institutions- We all know about about the gross injustices related to Henrietta Lacks and the Tuskegee Experiment and many of these concerns continue to plague the Black community. Concerns about becoming a part of some unknown project or being a guinea pig for some drug are common.
Cost- Finances continue to be a reason why some Black women may forego the idea of trying psychiatric medications. However, there are plenty of psychiatric meds that are only $4 for a month’s supply and there are also patient assistance programs sponsored by the drug companies to help with the costs of necessary medications.
So what can you do if you are considering meds but still afraid to take that step? Here are a few helpful tips:
1. Talk with your therapist about your fears. Sometimes clients are afraid of how meds will change their personality. Other times they are afraid of what taking medication really means. Having a conversation where you give voice to your fears may be incredibly helpful.
2. Just set up the appointment. I always tell my clients that the decision about whether or not to take meds will always ultimately be their choice. But if you even remotely think that meds will help you to function better and improve your mental health, you owe it to yourself to at least make the first appointment. You can hear what the psychiatrist has to say and ask all of your questions and then make a decision about whether or not it is something you want to try.
3. Give the meds a fair chance. Psychiatric medications are not magic pills. You will not take your first dose on Friday and wake up careless on Saturday morning. Many times you may have to try a few different meds to find the one that is the best fit for you and you should expect that any of the meds you try will have some type of side effect. Most of the psychiatrists I have worked with suggest that you keep taking the meds for at least a couple of weeks to see if the side effects go away and the benefits actually outweigh them.