Like Freud, much maligned, much misunderstood. I mentioned earlier that if you need immediate relief from seriously disruptive symptoms, sometimes medication is your only choice. This applies to intense panic attacks, other serious anxiety symptoms (hives, heart palpitations, dizziness), severe and debilitating depression, severe obsessive behavior (hand washing, counting, checking, other behavior rituals), violent and other antisocial behaviors, and psychosis. Psychosis is a severe break with what most of us consider reality -- the paranoid who believes Martians are living in the basement and manipulating his mind during sleep, the schizophrenic who hears voices commanding him to commit dangerous or bizarre acts, even the obsessive-compulsive who is convinced he must walk on all sidewalk cracks or catastrophe will befall him. 

But medication is extremely useful and at times essential in many, less flamboyant situations. This is another reason I stated my bias that you should seek a widely experienced psychotherapist. That therapist will be best prepared to detect the time and need for medication, and to send you to a psychiatrist for evaluation. [Jill]

Medication is not a substitute for psychotherapy. Medication and psychotherapy attack different problems and achieve different ends. Sometimes medication alone is best, usually not. The medication that helped Jill stop obsessing would not have stopped her lifelong habits of feeling angry, blamed, and victimized, nor changed the personality and repertoire of behavior she developed in response to these feelings. Personalities, lifelong ways of experiencing the world and one’s self, do not evaporate because of a pill.

What the pill does is quiet the emotional storm that has all these years fueled the development of that personality, thus allowing new learning and new habits to develop. As one of my favorite psychiatrist colleagues puts it, "sometimes you need that little bit of medication and then the therapy can really take off".  

Important: Do not go to your family physician for a prescription of psychiatric medication. Unless you luck into the right medication quickly, this route can be extremely discouraging. This kind of medication requires a specialist to sift through all the vagaries and subtle differences among the medicines and among patients to select the best one for you. Furthermore, one’s inner life -- one’s thoughts, feelings, perceptions, experiences -- are notoriously difficult to describe. You should be seeing an expert in such inner life so that your efforts to describe what hurts or how a medication is affecting you are understood. So this is not the best place to skimp on money and effort.


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