Dr James Davies: Let’s be clear about pill shaming

Today the BBC published an article on ‘pill shaming‘, asking for us to put end to it.

In short, it depicts a young woman talking about how certain people in her life (her family, friends and some strangers) have made her feel about taking antidepressants. Some implied that she should ‘try harder to make herself better’, others said she is ‘weak for taking the pills’ or ‘why not just eat better’.

What was so important for me about this film is that for the first time a clear definition of ‘pill shaming’ seems to emerge – namely, the act of disparaging or shaming people for either taking or wanting to take antidepressants (e.g. calling them weak, asking them to try harder etc.). In fact, the BBC goes one step further by offering us an explicit definition of pill shaming: the act of making others ‘feel guilty for taking medication for their mental health’.

I like this definition, because, according to it, I would agree that what is being called ‘pill shaming’ is both wrong and indeed does happen. In fact, the sad thing is that this phenomenon is not just restricted to taking pills. We all know examples of what we could call ‘therapy shaming’ or ‘mindfulness shaming’ or ‘counselling shaming’. In short, whenever someone is shamed for simply trying to help themselves (especially if they believe the intervention works) we should call that behaviour out.

Insofar as the term ‘pill-shaming’ is used in the above manner, then, I believe it may have its place. Where I believe it clearly has no place, is when it is used indiscriminately to either misrepresent, dismiss or discourage legitimate criticism of drugs (a mistake which, thankfully, the BBC does not make in its video). I say this because, unfortunately, and in the past, the ‘shaming’ epithet has been used in precisely this loose or ad hominem fashion; in an attempt to lump important criticism into the category of subtle abuse. This is achieved by either explicitly mislabelling legitimate critique as ‘pill shaming’ or else more subtly implying that any legitimate evidence-based criticism of the drugs inevitably fuels or leads to pill shaming.

When the above strategies are deployed by those who feel they have to promote or defend the drugs, then it is also right that we call them out. New trending terms in mental health are neither here nor there – it is how they are used that counts.

12 Responses to Dr James Davies: Let’s be clear about pill shaming

  1. ConcernedCarer 20/11/2018 at 1:02 pm #

    Do you really think people say “don’t take those things, just try harder?”

    Lol of course they don’t, for the simple reason that if someone is depressed enough to be on AD’s no-one, but no-one, is going to rock the boat – its too dangerous! More commonly people will say, rather unhelpfully, “oh you are doing really well”, but thats because they are trying to help.

    I DO suspect some people do feel a slight sense of weakness or shame for being on them, but thats not because of what people say to them. I think its because they are unsure themselves of the benefit/harm ratio of what they are taking and think they may be making a mistake, but thats not because of what people say to them. It might be because of published evidence about “on average, no better than placebo”, but if those are the facts people can always check it out for themselves.

    We all know the reason for this – its a tactic aimed at smearing the motives of those noble scientists who are trying to publish the truth. And its because there is no evidential defence for 1 in 6 in England being on drugs of such marginal value.

    The RCPsych owes it to the 1 to 6 to put forward a robust evidential defence for ADs, if they really hold the view that ADs work. For those on AD’s, I feel annoyed that the people who put them on the drug will not stand up and defend them with any semblance of evidence.

    • kiwi 20/11/2018 at 6:28 pm #

      Well said concernedcarer,

      This pillism on people is just another tactic (reverse psychology) by those with pharma agendas to actually do non-pillism (non-pill shaming) on people.

      Most people friends and family included are so ignorant and clueless that they really do believe the chemical imbalance nonsense and so much so that they are another pharma secret weapon by telling others to GO ‘see a doctor’ GO get help, Go phone the helpline which will be another drag net way of coralling peole into a doctors arms.

  2. Clive Sherlock 20/11/2018 at 1:31 pm #

    Dual messages are confusing

    Yes, people taking pills or having therapy really are told they are weak or feeble-minded and should pull themselves together. Others are told by family, friends and doctors that it’s not their fault, they have a chemical imbalance in their brain and need to take pills to correct what is wrong.

    I meet them every day and hear the same comments again and again.

    What to do? Condemned if you do and condemned if you don’t.

    Society at large is now split between pill lovers and pill haters (much as it is split over Brexit) and we are rapidly losing faith in the medical profession for treating mental ill-health (as we are in politicians for leading the country). Of course there are those who don’t know what to make of either side.

    The discussions on the Council For Evidence-based Psychiatry would help clear the confusion but only if both sides consider them with an open mind. And we should all be grateful to those who are openly discussing these vitally important issues.

  3. Fiona French 20/11/2018 at 2:00 pm #

    Thank you very much for highlighting the very serious issues associated with this subject. As a member of the prescribed harmed community and campaigner on prescribed harm, the film is clearly being used as a device to try to silence our voices. Indeed it has been suggested to me on Twitter today that we should be careful of how we recount our stories of harm for fear of upsetting others who may potentially benefit from psychiatric drugs. My view is that if RCPsych had actually agreed to take these matters seriously, had agreed to meet with campaigners to address the issues, this would have been a huge step forward in diminishing the anger in the prescribed harmed community. Indeed Wendy Burn stated on Twitter that a meeting would be held in November, to date I have heard nothing about the details of this meeting. I assume there is no such meeting.

  4. Ruth Smith 20/11/2018 at 3:41 pm #

    I think that one of the main problems in this debate about prescribed psychiatric medication is that people are not given correct evidence based information before they decide whether to take the pills or not. People need to know what the likely effects might be – both beneficial and adverse. Also, whether it will be easy or difficult to withdraw from the medication – both short term and long term. In my experience, some doctors will prescribe these pills without thinking that it is their patient’s decision whether to take them or not. Informed choice is the key backed up by evidence. Some people will decide to take them whilst others will decide not to. Also, if somebody decides to take them and then finds they are not helpful, then they should be supported properly in tapering off the medication.

  5. Auntie Psychiatry 20/11/2018 at 3:51 pm #

    Your title is “Let’s be clear about pill-shaming”, but after reading the piece I couldn’t be less clear…

    “In fact, the BBC goes one step further by offering us an explicit definition of pill shaming: the act of making others ‘feel guilty for taking medication for their mental health’.

    I like this definition, because, according to it, I would agree that what is being called ‘pill shaming’ is both wrong and indeed does happen.”

    James – could you post some links to online examples of this? I don’t use Twitter or Facebook, so maybe it’s all going on there, but I haven’t come across it.

  6. Stevie Lewis 20/11/2018 at 5:01 pm #

    Thank you writing about this, James. I have just watched the BBC video a little apprehensively and found it quite reasonable. I have been becoming more and more uneasy about this phrase “pill shaming” and how it crops up regularly and negatively in relation to our campaign to highlight prescribed drug dependence. What disturbs me is the lack of respect in the media and social media for peoples’ views and beliefs on this subject. To me it is perfectly credible that an individual chooses to take a drug such as an antidepressant, finds it helps them and can decide to stop it with minimum effects. I respect their viewpoint and I am in fact envious of them because my experience was the absolute opposite! Better informed consent is a fundamental change that is required, and being actively campaigned for, but that doesn’t alter the validity of the individual’s viewpoint. The Royal College of Psychiatry is clearly championing this right, whatever their motives. What irks me, though, is how this does not swing both ways. I have been personally “withdrawal shamed” many times by doctors and neurologists, and of course more recently via the media campaigns earlier this year (two weeks and self-limiting? I wish!!). It is now time for the RC Psych to present a similar story in the media, acknowledging that the harm done to so many of us is as real as the help given to the 70 year-old man in Wendy Burn’s jolly little story.

  7. Fiachra 21/11/2018 at 1:51 am #

    They call it Mental illness, because it’s an illness…

    For me the solutions were in the non illness approach.

    The first self help book I ever came across was “Your Erroneous Zones” by Psychologist Dr Wayne W Dwyer in the early 1980s and by coincidence I was at the time, attempting to withdraw from Depot Fluphenazine Decanoate – a drug used for the “Very Serious Longterm Illness” of “Schizophrenia”.

    I tried lots of different approachs, and eventually I found the psychological means I needed to deal with my withdrawal “High Anxiety” – and I was then able to move away from the Hospitalisations (acute akathisia), Disability (chronic akathisia), and the “Mental Health” System (permanently).

    I also suffered from dreadful (nondisabling) melancholy but thankfully Buddhist Breathing Meditation put an end to this (permanently).

    As far as I know, Dr Wayne Dwyer never claimed any talent regarding the alleviation of the “Severe Mental Illnesses”, but he did mention how happy he was to escape the institutions and the stench of “Largactil” laced urine in the bathrooms. I’m happy he did escape and write the book “Your Erroneous Zones” as it played a part in taking me away from these type of environments (permanently).

  8. Steve 21/11/2018 at 4:08 am #

    The first and most egregious error of the current psychiatric model is assuming that we can accurately categorize people by symptoms and expect to get rational results. Why would be believe that EVERYONE who suffers from, say, panic attacks has them for the same reason? This would be like assuming that everyone whose knee hurts has the same problem, or that everyone who finds school dull is mentally impaired, or that all people who are vomiting have “vomiting disorder” and looking for a cure for vomiting. It is utter nonsense! People feel anxious for a wide range of reasons, some of which have to do with things like loss of sleep, bad relationships, poor eating, childhood trauma or neglect, bullying, lack of parental discipline skills, and on and on. Moreover, people’s culture will dramatically affect how they frame these issues, what kind of approaches make sense to them, and even what will ultimately work to help them. As long as psychiatry continues to market (and yes, it has been a HUGE marketing effort to get people to believe this particular piece of idiocy) the idea that all depressed people or anxious people or whatever have a “broken brain” or “bad genes” simply because they have a particularly intense experience, we will continue to have discussions about what is or is not working in helping people with these experiences, and those discussions will continue to be emotionally intense.

    “Pill shaming” really does happen, but as the author correctly points out, this meme has been shamelessly used to shame any critics of psychiatry into keeping quiet. It’s actually extremely disempowering and infantilizing to their clients to suggest that they are so impaired as to not be able to handle the truth! This kind of condescension is what got psychiatry into the trouble they are in. We can’t let them get away with blaming it on those who are committed to setting the record straight.

  9. Physician 21/11/2018 at 11:10 am #

    The great “SHAME”s applicable to the prescribing of SSRI/SNRI and “atypical”
    antidepressants are : –

    1) That patients and their families, loved ones or other householders are not warned about the very serious risk of AKATHISIA and its sequelae.

    The FDA have a 33 page package insert for fluoxetine:

    Search for example: “Prozac package insert”. The AKATHISIA risk is well identified (now).

    Akathisia is not merely restlessness.
    It is a writhing, intolerable, drug induced, agonising torment for the sufferer and for their loved ones who watch and despair.

    2) Prescribers remain under-informed, unaware or in denial of this common, life threatening Adverse Drug Reaction.

    3) That when the physical, emotional, and psychological manifestations of AKATHISIA present, and advice is sought – the intense neurotoxicity is so often misdiagnosed as
    “Severe Mental Illness”.
    This can result in Incarceration, and forced “medication” with drugs producing inevitably even more intense AKATHISIA with risk of Serotonin Syndrome/Neuroleptic Malignant Syndrome.

    When people who were given SSRIs for minor normal day to day stressors, with no depression whatsoever, can have their physical, psychological, social, emotional health and economic wellbeing destroyed by the serial inappropriate “diagnostic labels-for-life’ and both medical and societal rejection: this is indeed “SHAME”ful.

  10. Dr Neil MacFarlane MRCPsych 21/11/2018 at 7:51 pm #

    James Davies writes ‘I would agree that what is being called ‘pill shaming’ is both wrong and indeed does happen.’

    Does he agree that pillshaming is encouraged by his fellow CEPUK ‘members of council’ Dr Joanna Moncrieff, who has stated ‘there’s no such thing as an antidepressant’ (https://drnmblog.wordpress.com/2018/04/18/pillshaming-is-real-heres-a-newish-way-to-reduce-it-and-to-reduce-antidepressant-use/), and Peter Goetszche, who has disparagingly called them ‘happy pills’ (https://www.madinamerica.com/2014/01/psychiatry-gone-astray/)?

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