Aug 23, 2025 02:56 AM
Simplistic debates about the drugs obscure the complex dynamics of how psychic pain is understood and treated.
https://undark.org/2025/08/21/opinion-an...sant-trap/
EXCERPT: . . . Yes, antidepressant withdrawal is real. Yes, some people suffer greatly while trying to come off these drugs, with withdrawal risk varying among different kinds of antidepressants. I have also seen many patients appear to benefit greatly from such medications. But when we focus only on the biology of response and withdrawal, or treat psychiatric medications as purely pharmacologic agents whose harms and benefits can be definitively measured and settled by clinical trials, we obscure the more complex — and far more consequential — dynamics by which these medications affect self-perception, social relationships, and political life.
Although antidepressants have an appropriate place in psychiatric treatment, they’re frequently prescribed in cases where they are unlikely to do much good. The risk of harm commonly outweighs likely benefits, especially under the norms of highly time-constrained, decontextualized, and impersonal clinical practice today, in which medications are often prescribed at the very first appointment. And while I am a critic of the overprescription of antidepressants, I am also wary of the growing public discourse that treats them and psychiatry itself as the primary cause of ongoing pain.
In some cases, what gets labeled as withdrawal is not a straightforward physiological reaction to discontinuing a chemical agent. It can be a complex response to the loss of an object that was invested — often by one’s doctor, one’s family, dominant cultural ideas, and patients themselves — with enormous psychic and symbolic significance. If a pill is presented as a cure for debilitating anxiety tied to grief or trauma, for example, or accepted by a patient as a last-ditch attempt to stave off despair and self-harm, its failure to deliver relief can be devastating and worsen the distress that led to starting the medication.
Symptoms after stopping medications can also represent the return — whether in new or old forms — of underlying suffering that was never addressed. This often happens in part because treatment has primarily revolved around generic symptom checklists and decisions on what medications to use rather than meaningful engagement to understand a patient’s experience in the context of their unique life history, needs, conflicts, and desires.
This isn’t a claim that withdrawal symptoms are “all in your head.” It’s a repetition of the well-known but widely disregarded reality that mind and body are not separate, and neither are biology and culture. Symptoms emerge in particular social contexts and take shape through the meanings we attach, typically without our awareness, to them. This is how, for example, what was once considered ordinary sadness or grief has been transformed into a symptom of depression, or how experiences of fatigue or loss of interest that might come from overwork or boredom have been recast as mood and attention disorders.
How we name our experiences and how people around us respond to them affects, in turn, how we feel and navigate them. This culturally contingent nature of symptoms also holds true for the experiences of taking and stopping medications like antidepressants, and it’s true for the conditions they’re meant to treat.
Psychiatry, since the 1970s, has fostered a widespread misrecognition of psychic suffering as the product of discrete brain disorders. This medicalizing narrative has encouraged people to understand their experiences of distress as, first of all, a biological problem to be chemically treated. And when the chemical fix fails, which psychiatry’s own data show it often does, patients are left not only with their original problems but also with a sense of betrayal and confusion. Some come to attribute their suffering to psychiatrists and medications themselves. In some cases, that attribution is almost certainly correct; there are reckless doctors and serious medication side effects. But it’s rarely so simple.
This misrecognition often reflects a deeper one that psychiatry has long cultivated: a tendency to conflate complex social and psychic distress with biological dysfunction. It then fuels what medical science calls the nocebo effect — a negative placebo response — whereby suffering becomes attached to and caused by the idea of a drug, even when the chemical effects of the drug are not in fact the direct cause of one’s symptoms. The nocebo effect, in this case, is not incidental, nor does it mean that psychiatry is not responsible for it. It is an unintended consequence of the very narratives that psychiatry has used to justify its authority and economic value.
Psychiatry has offered simplistic diagnostic labels as if they, by themselves, provide adequate explanations. The result is a vicious cycle: A culture prescribes pills in response to psychic pain, then blames those pills for pain when it persists.
Myriad unintended consequences ensue... (MORE - missing details)
https://undark.org/2025/08/21/opinion-an...sant-trap/
EXCERPT: . . . Yes, antidepressant withdrawal is real. Yes, some people suffer greatly while trying to come off these drugs, with withdrawal risk varying among different kinds of antidepressants. I have also seen many patients appear to benefit greatly from such medications. But when we focus only on the biology of response and withdrawal, or treat psychiatric medications as purely pharmacologic agents whose harms and benefits can be definitively measured and settled by clinical trials, we obscure the more complex — and far more consequential — dynamics by which these medications affect self-perception, social relationships, and political life.
Although antidepressants have an appropriate place in psychiatric treatment, they’re frequently prescribed in cases where they are unlikely to do much good. The risk of harm commonly outweighs likely benefits, especially under the norms of highly time-constrained, decontextualized, and impersonal clinical practice today, in which medications are often prescribed at the very first appointment. And while I am a critic of the overprescription of antidepressants, I am also wary of the growing public discourse that treats them and psychiatry itself as the primary cause of ongoing pain.
In some cases, what gets labeled as withdrawal is not a straightforward physiological reaction to discontinuing a chemical agent. It can be a complex response to the loss of an object that was invested — often by one’s doctor, one’s family, dominant cultural ideas, and patients themselves — with enormous psychic and symbolic significance. If a pill is presented as a cure for debilitating anxiety tied to grief or trauma, for example, or accepted by a patient as a last-ditch attempt to stave off despair and self-harm, its failure to deliver relief can be devastating and worsen the distress that led to starting the medication.
Symptoms after stopping medications can also represent the return — whether in new or old forms — of underlying suffering that was never addressed. This often happens in part because treatment has primarily revolved around generic symptom checklists and decisions on what medications to use rather than meaningful engagement to understand a patient’s experience in the context of their unique life history, needs, conflicts, and desires.
This isn’t a claim that withdrawal symptoms are “all in your head.” It’s a repetition of the well-known but widely disregarded reality that mind and body are not separate, and neither are biology and culture. Symptoms emerge in particular social contexts and take shape through the meanings we attach, typically without our awareness, to them. This is how, for example, what was once considered ordinary sadness or grief has been transformed into a symptom of depression, or how experiences of fatigue or loss of interest that might come from overwork or boredom have been recast as mood and attention disorders.
How we name our experiences and how people around us respond to them affects, in turn, how we feel and navigate them. This culturally contingent nature of symptoms also holds true for the experiences of taking and stopping medications like antidepressants, and it’s true for the conditions they’re meant to treat.
Psychiatry, since the 1970s, has fostered a widespread misrecognition of psychic suffering as the product of discrete brain disorders. This medicalizing narrative has encouraged people to understand their experiences of distress as, first of all, a biological problem to be chemically treated. And when the chemical fix fails, which psychiatry’s own data show it often does, patients are left not only with their original problems but also with a sense of betrayal and confusion. Some come to attribute their suffering to psychiatrists and medications themselves. In some cases, that attribution is almost certainly correct; there are reckless doctors and serious medication side effects. But it’s rarely so simple.
This misrecognition often reflects a deeper one that psychiatry has long cultivated: a tendency to conflate complex social and psychic distress with biological dysfunction. It then fuels what medical science calls the nocebo effect — a negative placebo response — whereby suffering becomes attached to and caused by the idea of a drug, even when the chemical effects of the drug are not in fact the direct cause of one’s symptoms. The nocebo effect, in this case, is not incidental, nor does it mean that psychiatry is not responsible for it. It is an unintended consequence of the very narratives that psychiatry has used to justify its authority and economic value.
Psychiatry has offered simplistic diagnostic labels as if they, by themselves, provide adequate explanations. The result is a vicious cycle: A culture prescribes pills in response to psychic pain, then blames those pills for pain when it persists.
Myriad unintended consequences ensue... (MORE - missing details)
