Psychopills: using psychotropic drugs in an ethical and strategic way

One in five Italians takes psychiatric drugs for a total cost that in Italy alone exceeds 3 billion and 300 million euros. A real boom in the sale of psychotropic drugs that are now prescribed and taken also to manage the normal difficulties, anxieties and discomforts of everyday life.

The tendency to medicalize any negative emotion or feeling typical of our well-being society is leading more and more to the illusion that the "healthy" existential condition is that of "happiness at all costs and at all times" and that those who do not live in this condition have a psychological, or even worse, biological problem that needs to be corrected with a drug.

For several years we have been witnessing the unstoppable and alarming trend of to extend the idea of ​​mental illness to an increasing number of aspects of human life. so practically none of us can be considered "healthy" according to the latest version of the so-called "Bible of psychiatry," the DSM-5. In fact, if we follow the criteria of this manual, almost 25% of the population seems to suffer from a mental disorder at least once in their lifetime.

Here then is that the reaction of mourning for the loss of a loved one becomes a depression, shyness becomes social phobia, the lively and rebellious child that the teacher cannot contain becomes the sick child who must be treated, preferably with a psychotropic drug that it will turn him into a model student.

The confidence in the progress of medicine typical of our century, fueled and amplified to excess by the economic interests of the pharmaceutical industry, is leading more and more to believe that there is a psychopill to solve any discomfort and, at the same time, that every discomfort can be overcome. only thanks to a psychopill.

In reality, this is not the case: not all emotional, relational and psychic sufferings are diseases that require drug therapy to be resolved. In fact, drugs can be superfluous if not harmful if used to treat disorders that do not belong to the "biochemical" sphere of the individual, but to the complex set of relationships that the person has with himself, others and the world.

In the words of the father of medicine Hippocrates, "similia similibus curantur" (similar things are cured by similar things): if a problem is generated at a family, cultural, social, interpersonal level, the best way to deal with it is to act at the same level ; on the contrary, if the problem is biologically generated, the privileged treatment will be the psychopharmacological one.

In this wake, the results of the latest scientific research have shown that the drug it represents the central part of the cure only in some very severe situations, such as in cases of psychosis, bipolar disorder or severe depression. In all other cases, psychotherapy, and not psychotropic drugs, is the treatment of choice. This applies, for example, to all the so-called "anxiety disorders" (panic attacks, obsessions and compulsions, phobias, hypochondria, etc.). In fact, at the base of these disorders there is not an anomalous functioning of the anxious response, as their name would suggest, but an alteration in the perception of fear of certain situations (internal or external) that trigger an anxious reaction.

As also highlighted by neuroscientist Joseph LeDoux, the drug can inhibit anxious reactions, but it cannot change the perception of fear. Therefore, an intervention that wants to be effective and efficient cannot be limited to blocking the anxious reaction, but must intervene on the person's fearful perception. In these cases, psychiatric drugs can even make the situation worse when the person uses them as "crutches" thus becoming less and less able to "walk" alone.

The same is true for eating disorders (anorexia, bulimia, vomiting and binge eating) in which international guidelines indicate psychotherapy (individual or family depending on the situation) as the most effective treatment without the need to resort to psychotropic drugs. . The therapies that have proved most effective for the treatment of these disorders, in the light of the most recent scientific evidence, are cognitive-behavioral psychotherapy and brief strategic therapy.

Finally, we must not forget that in the psychological field the word "cure" is often used interchangeably to refer to the concept of "healing", understood as the total resolution of a disorder, rather than just the "management" of its symptoms.
Psychotropic drugs, in fact, belong to the category of "symptomatic" and non-curative treatments, that is, they are not able to "cure" mental disorders but are configured, depending on the case, as interventions aimed at "managing" the symptoms or support the healing process, which however takes place thanks to other types of interventions, such as psychotherapeutic ones.

But "healing" and "managing" are obviously not the same thing, and the professional who wants to take an ethical and strategic position towards patients must therefore privilege, where possible, interventions capable of leading to the total extinction of the disorder and re-establishment of the condition of well-being of the person. Only when, in "science and conscience", healing does not seem to be achievable, will it be important to resort to treatments that allow you to manage or buffer the disorder in the most effective way possible.

As claimed by the great psychiatrist Philippe Pinel "It is an art of no small importance to administer medicines properly, but it is a more important art to know when not to administer them at all".

Dr. Roberta Milanese (Psychotherapist, lecturer and official researcher of the Strategic Therapy Center)

Bibliography:
Caputo, R. Milanese (2017), Psychopills. For an ethical and strategic use of drugs, Ponte alle Grazie, Milan.