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There's a stimulating opinion piece in today's Washington Post by Charles Barber about drug treatment and mental illness.

Feeling depressed? No problem, pop a pill.

That does seem to be the way of things these days. I pop one of the pills you see illustrated here once a day to treat my depression.

And why not? The television ads make it seem so easy: An agonized man or woman stares listlessly into space or slumps on a bed or couch, holding their head in their hands. Then they take a pill and suddenly morph into a happily engaged and joyous being, back on the job or walking in a park, awash in sunshine, surrounded by grandchildren, a golden retriever nipping at their heels, while lush music plays in the background.

But recovering from mental illness is rarely that simple. I know.

And he is right. To be sure, those wonderful pills keep me well back from the black abyss of depression that only those who have suffered it really know, but they are building on years and years of extensive pyschotherapy that did its very best to rearrange my mind.

But beyond the anti-easy-drug argument, Barber has a more subtle agenda, almost an anti-treatment agenda:

But when you speak to people with severe mental illness who have gotten better, you learn about the reality of the recovery process, which is rarely about a pill — even if that pill is effective. When you interview patients about how they got better, they hardly ever cite Prozac or Zyprexa or lithium. For that matter, they rarely cite a particular doctor or therapist or treatment program. Rather, they talk about a person who was kind to them when they were really down; they talk about the child they wanted to be a good parent to; they talk about God and spirituality; they talk about something that brought them pleasure even when they were cloaked in pain. Many of these reasons to live — the reasons to seek treatment in the first place — are highly personal and idiosyncratic, as was mine.

Although there are elements of truth in what he says, I think he in denial as to the 'reality' of the recovery process. I, myself, would not hesitate to say what he considers people rarely say – namely there is no doubt in my mind that a combination of the pyschotherapy and drugs that made me better. People have a natural reluctance to admit this – it is easier to credit friends or God, more socially acceptable one might say. His failure to acknowledge this reticence fatally undercuts his, inevitably anecodotal, argument.

Ultimately, his is a voice I have frequently encountered during my exposure to fellow sufferers of depression, the 'I can do it on my own, with a little consulting help' voice:

Treatment works best when the doctor or therapist acts as a kind of expert consultant. As Home Depot puts it: "You can do it, we can help."

Sometime that works; more often, in my experience, it has not. Pyschotherapeutic treatment requires an element of surrender, of admittance of powerlessness, before it can take root. To be sure, there has to be a will that drives you into and sustains you through what can be a very painful time, but that drive is far different from that required for the almost casual, retail, form of treatment that Barber seems to favor.

This was not a helpful article.

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