The “Pills are Evil” Trope

Although I mostly enjoyed Brooke Soso’s plotline in the latest season of Orange is the New Black, the narrative arc exploring depression had one major flaw: it suggested that a therapist giving Soso a prescription for anti-depressants was dangerous and negligent, and that only therapy could possibly help her.

And this is a common problem even in progressive fiction. Therapy gets a pretty fifty-fifty treatment — some stories present it was pointless and weak, while others invoke it in a more positive way — but prescription medication for mental health is almost always presented as a bad thing. Anti-depressants, according to these stories, numb your emotions and transform you into a different person. They are not treatment but torture, and no one who actually wants to “be themselves” will take them.

From a narrative perspective, this sort of makes sense. Stories need villains, something concrete for characters to struggle against, and when the plot is about mental illness, an uncaring doctor who just wants to prescribe personality-destroying medication can fill that role fairly easily.

But this narrative of the individual triumphing over mental illness without resorting to zombie pills is incredibly harmful. Studies show that mental illnesses like depression are best treated by a combination of medication and therapy. Yet fiction tells us, again and again, that medication is bad, spreading dangerous misinformation adding an extra stigma to receiving treatment for an already stigmatized condition.

It is ultimately an extension of the myth that people with mental illness, and especially people with depression, should simply be able to will themselves better. By saying that pills designed to treat a medical condition by targeting chemical imbalances in the brain change you, or that they’re cheating your way to happiness, stories are saying that pills are not a real solution, and that people who recover without medication are being more genuine and more true to themselves. Even the suggestion that pills make you into a zombie echoes those same roots — depression won’t zombify you, but treatment will!

This is a worrying message in any fiction, but I find it particularly concerning in young adult literature, and particularly in young adult literature that claims to be about mental health and mental health awareness. I wrote earlier in the year about how “suicide YA” seemed to be the big new contemporary trend, but although many of these books receive a lot of praise for being hard-hitting and honest about mental illness, they often simply perpetuate these myths to a potentially vulnerable audience.

For example, All the Bright Places, a very successful novel about a girl with depression and a guy with undiagonised bipolar disorder, features characters claiming that medication takes away who you are, without these ideas being challenged at all. When the protagonists meet people at a support group, they’re described as having “the dull, vacant look of people on drugs” — rather than, I suppose, the dull vacant expression of someone being utterly destroyed by crippling depression. And these ideas last to the end of the book. Even though a character commits suicide because of their untreated mental illness, no one ever suggests that maybe medication isn’t so awful after all. All you need is love, and a bit of determination.

Then there’s I Was Here, where a character with depression throws away her prescribed anti-depressants, saying, “It’s better to feel this than to feel nothing.” At the end of the book, the girl’s parents say that she was better when she took medication, and died because she stopped, but there’s no correction of the lingering idea that “better” meant “zombie.”

Or The Last Time We Say Goodbye, where a character compares anti-depressants to drugs that stop you feeling things, with the bonus suggestion that as another character took anti-depressants and still committed suicide, they don’t work anyway.

I’ve never seen medication treated purely as a good thing in a novel. I’ve never seen characters resist it and then be proved wrong. I’ve never seen a story tackle the idea that there are many kinds of anti-depressants, and if one has unpleasant side effects (even ones far less all-encompassing than “feeling like a zombie”), a person can switch the medication and find one that actually works for them. Instead, they echo lazy stereotypes, without correcting them, and so stories that claim to be designed to help teens dealing with depression and suicide further stigmatize things that teens may already be feeling wary about.

Of course, there are problems with doctors prescribing medication but not offering therapy, with anti-depressants as the medical “easy way out” (as is the case in England, where the waiting lists for therapy can stretch on over a year). But this is not an either-or proposition, where medication is bad and therapy (or, worse, determination) is the holy grail. No one would ever say “diabetics only need to control their diet, and if they ever need insulin injections, they’re weak and changing who they really are.” So why would we perpetuate the same idea about mental illness? By allowing stories to get away with these lazy stereotypes, under the guise of “helping” and “informing” readers, we allow for the perpetuation of ideas that seriously harm vulnerable readers and may prevent real people from getting the help they need in the future.

Yes, therapy is important. Yes, medication is stigmatized, and stories can explore that. But that doesn’t mean stories are allowed to restate old myths again and again, all under the guise of “diversity” and “progressiveness.”

11 comments on “The “Pills are Evil” Trope

  • RR Gilmore , Direct link to comment

    Thanks for tackling this – though I wish you didn’t have to, I’m glad you did. It’s an all too common narrative in our society and quite frankly, I expect better things from fiction!

    If I recall correctly (it’s been a while!), “It’s Kind of A Funny Story” had its main character (living with depression) move from stopping his medication to taking it. It would be good to see more of that!

  • rosehustle1 , Direct link to comment

    Your comparison to diabetics is actually a similar one I use when talking with my clients about antidepressants. I am a mental health counselor and sometimes people are so against taking any medication that using this comparison is the only way to get them to try. I never offer antidepressants lightly or without letting the client understand that sometimes it takes a while to find the right one. What I have noticed is that people are either completely against medication or they want to find one magic pill that will solve everything. There never seems to be a balance. I do understand some of the flack that certain anti-psychotics get because they can make people feel very lethargic and emotionally disconnected. A lot of times Bipolar clients get off their meds because they miss the emotional rush they felt without them. I just think that a lot of the media seems to be anti-medication because of misunderstandings about how these drugs work. A client of mine even said that her new boyfriend was upset to know she takes antidepressants because he wondered if the way she has presented herself is her true self. These medications can help people actually be closer to who they really are because they are not overwhelmed by anxiety, depression, or psychotic hallucinations.

    • Rhiannon , Direct link to comment

      Thanks so much for your professional input on this. I should have been a little more careful with my wording in this post, I think, as I was mostly talking about depression/anxiety, and of course different medications for different illnesses can have very different side effects. But that story about the client and her boyfriend is heartbreaking. These misconceptions can be so harmful in so many ways.

  • Katharina , Direct link to comment

    I recently read “Finding Audrey” by Sophie Kinsella, the first time I tried her and I was pleasantly surprised. It’s a very light and cute story, but the main has an anxiety disorder which is treated with a lot of sensitivity and respect. I was afraid it would have a “Boy saves sick Girl” storyline, but, while there is a love story, it’s never about that and always about her trying to get better and accepting help to do so. ANYWAY, it is also an example of pills not being “the bad guy”, and when Audrey stops taking them, it is eventually shown as the wrong path.

    • Rhiannon , Direct link to comment

      I’ve never tried any Sophie Kinsella, but I think I’ll be adding this one to my holiday reading list. Thanks!

  • Jessica McKelvin , Direct link to comment

    It has taken me so long to finally be willing to try medication because of that fear of pills. The fear that they would change how I felt and take away the good parts. Now I accept that if I find the right one it will take away just the bad, and I’ll still have my good days just more of them. I gave up trying just medication prescribed by my regular doctor and now want to explore a therapy/medication combination.

    • Rhiannon , Direct link to comment

      It’s such a difficult thing, since so little about depression is understood, and that lack of understanding is so often used to discourage people from trying any treatment at all. I hope you manage to find the right solution soon!

  • Emily , Direct link to comment

    Thank you so, so much for addressing this, you make some excellent points. One of my best friends has been suffering from massive depression since the death of her parents a few years ago. She has since fought her way through emotional chaos, as she describes it, and dealt with suicidal thoughts many times. Recently she has been diagnosed with angst, depression and a psychosis, and she is now receiving help in the form of both therapy and medication, which has proven very effective to her mental health. Drugs might not help everyone, people are different from each other, but without the pills and the insanely talented doctors, my friend might not be alive today.

    • Rhiannon , Direct link to comment

      I’m so sorry your friend had to go through that. I hope she continues to get better.

  • voodooqueen126 , Direct link to comment

    If you’ve ever done a script writing class, one of the things they do is create a premise. One suspects that an easy premise/cliche to start with is ‘pills wont fix your problems’ and from that cliched line comes a very cliched plot.

  • Kat , Direct link to comment

    While I agree with you that this kind of story telling can further the stigma surrounding mental illness and that medication can be helpful for many, I think it is also important to note that it is not helpful for everyone. It is, as you correctly say, not the big evil. But it also is not the thing that will heal you. IMO this trope doesn’t come from a place of stigma and misconception exclusively — but from experiences some people do make. I think it is important to include these experiences as well for a truly balanced perspective. Because while, yes, presenting medication as evil can discourage people from seeking help, presenting medication as always working – even if after trying several combinations and types – can be just as harmful for people for whom medication has not been helpful. The idea that mental illness is a matter of will power comes into play here. If the meds don’t work, you are probably being deliberately uncooperative, not trying hard enough or made up your illness in the first place (and mentally ill people are all attention-seeking, or hadn’t you heard?). This can then result in not being believed or not being supported in finding other means of dealing with the illness. Which is why it is important to keep in mind as many different scenarios and options different people may face as possible and remember they’re all valid.

    Personally, I have tried various medications (in addition to therapy). None of the medications I tried have been helpful in the long-term. Most often, the side effects outweighed the positive effects (if there were any). I DID feel robbed of my core self. I only started feeling like “myself” after I discontinued taking my medications, and very slowly. When I see a doctor for the first time, they are usually surprised I am not on any medication and are generally eager to address this lapse. According to studies, the combination most likely to work is one of both therapy and medication, after all, right? Most of the time, they are not interested in my experiences or reactions to medications though and pressume to know better while simultaneously downplaying and denying risks and side effects. I have been told by mental health professionals to try medications that I know to be addictive. (They insisted they weren’t.) I cannot recount how many times I have been made to feel as if I were being deliberately difficult or trying to be “special” for not reacting well to medications. Which is the flip-side of “medication is helpful”.

    I know several people in both “team medication” and “team: it doesn’t work” and both should be valid. Reading posts and comments praising medication in this one-dimensional way makes me sick, TBH. It scares me because it contributes to the sort of stigma that I am regularly hurt and invalidated by and that justifies patients being forced and persuaded with lies and half-truths to take medication, often against their will (particularly in psych wards). Which definitely takes away your personality/ personhood.

What do you think?

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