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."