Issue 16: Why am I so afraid of medication?
On pill shaming, one author's dream for happier stories and my personal experience with antidepressants
These days, it seems more and more authors and celebrities are opening up to tell their stories in an effort to eradicate mental health stigma. But for many of us—including first-generation immigrants and individuals within Asian communities—mental illness is still often considered an “American disease,” one that’s rarely acknowledged at home.
That was certainly the case for me.
I grew up in Utica, New York, and knew my grand uncle only peripherally, from family gatherings here and there. But I did remember being intrigued by the fact that Uncle Roger, who was born in Mauritius but was of Chinese descent, had a Caucasian wife and that he was a board-certified psychiatrist.
Later, when I was a teenager, I began flipping through some old family albums and came across a young, mixed raced girl at a family gathering. When I asked about her, my aunt told me she was a cousin who had died of suicide.
Being raised by my grandparents—both of whom were very stereotypical Chinese immigrant parental figures—I don’t remember ever talking about feeling sad. The closest I came to confiding my anxieties was balking about doing certain tasks like making phone calls or speaking in public. My complaints typically wound up inviting lectures about needing to work harder and to stop being lazy.
My Grandpa would say things like, “Remember, there’s always room at the top,” and “You can shoot for the stars. Even if you don’t make it, you’ll get to the moon.”
There’s a reason why the immigrant workaholic parent is such a trope. I suppose that, when you think about American psychologist Abraham Maslow's proposed "hierarchy of needs," things like feeding your children and paying rent naturally take priority.
So-called “luxuries” like focusing on one’s feelings are often submerged under layers of stress and the overarching need to simply survive.
I had my first bout with depression in college, prompted by a thwarted romance, academic setbacks and a fear of the future. I don't remember telling anyone about it. In fact, most of my memories of that period are unclear. I do remember how impossible it felt to get out of bed.
Somehow, I convinced myself to try therapy, then immediately stopped attending sessions once I felt better. I was determined to prove that I was strong enough to persevere on my own. If I could just work a little harder...
During medical school, a professor once told me that you could diagnose a person with depression if talking to them made you feel sad, too. I guess it makes some sense. Having experienced depression, I remember being afraid that I would “drag down” my friends with my pain. That fear often led me to pull away from those I needed most.
But my professor's words are also incredibly misleading. There are a lot of people (myself included) who can front very well and hide their symptoms behind smiles and accolades. And the truth is, it's not just mental. Your brain chemistry affects your physiology, your heart rate, your sweat glands, your muscle contractions. This is something medical schools just don’t emphasize enough.
By the time I was in my fourth year of residency, I had been on antidepressants twice. Both times, when I emerged from the darkness, I convinced myself that I didn’t need medications anymore. I now know it was all an act of machismo.
As someone whose parental figures constantly pushed her to be “better” or more “accomplished” than those around her, I felt like a failure for not being able to overcome this mental illness.
Despite my being an MD with the education to understand the role of neurotransmitters, my "Eureka!" moment didn’t arrive until my psychiatrist matter-of-factly told me, "You know, you might just be one of those patients whose brain needs more serotonin."
What felt like a character flaw was simply translated to a natural chemical imbalance, though it’s important to note that depression itself is much more complex. Scientists say it’s not just mood regulation in the brain affecting any chemical imbalances. Stressful life events, genetics, and medical problems all play a role, too.
But the fact was, my psychiatrist believed this could potentially be managed. So why was I pushing back? I mean, I would never tell a diabetic patient that she was weak for needing insulin, right?
I’ve been taking medication ever since.
When I became a parent and witnessed my own tween’s stomach pains and moodiness transition into frequent avoidance, loss of interest in activities she once used to enjoy and overall withdrawal, I began having flashbacks of my own youth.
As I wrote in this essay, my focus as a mother quickly turned from Girl Scouts and science fair projects to wondering what I could do to give my daughter the vocabulary she needed to identify her feelings, the permission to be sad and anxious, and the grace to understand that it’s not shameful to seek help if you need it.
But it wasn’t easy. After all, I hadn’t grown up with the tools to navigate this with my daughter.
I slowly learned that trying to be my child’s therapist wouldn’t work. It was so hard to just listen! I kept falling into “this is what I would do” advice-giving, which invariably had her bristle. I also had to figure out how to keep my own panic at bay. I tried instead to encourage my daughter to gently follow her interests.
Reading, music and theater helped turn things around for my child and bring back the happy-go-lucky spark that had begun to fade. These activities stimulated all aspects of herself, including her body while dancing. Being in a theater production also allowed her to be part of creating a work of art that was something greater than the sum of its parts.
But it also took therapy.
When I first hinted at the idea of counseling, my spouse would say things like, “I don’t know if it’s really to the point where she needs therapy.”
His extended family and I were able to convince him it’s never too early for therapy—that there’s more of a chance it’ll help her than cause any harm. And truly, it has worked wonders for our daughter.
For now, she’s not on medication, though I continue to be on high alert for physical signs like poor appetite and sleep disturbances. It’ll be a joint decision if we do choose to go for it, of course, but it’s especially nice that I’ll be able to share my own positive experiences with antidepressants if and when the time comes.
It’s important to me to be able to pass on stories that leave hope.
As I’ve been researching mental illness for my work and as a parent, I’ve noticed far too much of the narrative surrounding depression is focused on death by suicide.
This is harmful in two ways:
First, it ignores the earlier stages of identification, hampering prevention and a sense of hope. And second, when everything surrounding depression is about suicide, it plays into an all-or-nothing game where people who haven’t considered suicide may not seek help because they tell themselves that their mental illness isn’t “bad enough.”
Even when I sense that kind of ambivalence or reluctance about medication and therapy—or when I notice any significant distress among my own patients, I try to give them the chance to speak with a patient who’s tried the intervention—whether it’s a surgical intervention or medication. This is where stories can be especially powerful, because when people read about others and see themselves in those pages, sometimes it’s the first time they can envision the path forward.
If I had had the representation to give words and language to how I was feeling when I was younger, as well as examples of people who survived and thrived with mental illness, maybe I wouldn’t have struggled so much to get to where I am now.
A massive thank you to Ilene Wong Gregorio for sharing her story. Gregorio is out with a new book titled This Is My Brain In Love. It’s a YA contemporary romance novel exploring mental illness—with a happy ending.
Years of clinical research have proven that a comprehensive approach combining a prescribed regimen of psychiatric medication with psychotherapy results in the best outcomes for those suffering with a mental illness.
But even today, taking medication to help with depression, anxiety and other behavioral disorders remains highly stigmatized; medication is often viewed as a crutch for folks who don’t have the strength to manage their own problems.
The stigma associated with medications is sometimes referred to as “pill shaming” in mainstream media. It typically involves perspectives downplaying the need for medical intervention while suggesting the cure for most distress can be found in willpower, improved diet, exercise or faith. This isn’t to be confused with the stories of well-informed individuals who share their true, unsuccessful experiences with medication that may stray from the literature.
Pill shaming—whether the stigma is rooted externally or internally—is considered “one of the strongest deterrents for people wishing to continue medical treatment for mental health disorders,” Healthline’s Kimberly Holland reported in 2018.
Kim Meehan, a psychiatric nurse practitioner, told Teen Vogue that many of her clients feel starting medication is a “last resort.” When they opt in, they feel like they’ve failed. Many said they were told constantly to just “suck it up” or felt invalidated. Others were under the impression that “taking a medication is just a Band-Aid, but does not treat the cause.”
Add pill shaming to generations of immigrants with untreated illnesses, to various cultural stigmas, a legitimate mistrust of Western medicine and unrealistic pressures to be the model minority and you’ve only touched on the many factors that often keep immigrant communities from considering medication.
Despite being a doctor herself, Ilene, too, has had to overcome internalized barriers before she could embrace ongoing medication to help treat her chronic depression.
Just a few research highlights on medication stigma and use among immigrants with mental illnesses:
In this study population of 965 patients in the Netherlands, of which half consulted their doctor for issues unrelated to mental illness but were ultimately diagnosed with depression, anxiety, panic, or obsessive-compulsive disorder, non-Western immigrants were almost five times as likely to decline a doctor’s prescription for treatment compared to the general population.
It’s been established that once Asian Americans have a diagnosed mental disorder, “it tends to be very persistent, and they are less likely to seek treatment for psychological problems than European Americans.” In addition, one 2008 study found that Asian Americans with a “past-year depressive disorder” were significantly less likely to access any depression treatment compared to non-Latino Whites.
In Vietnam, which has one of the highest rates of drug nonadherence in the world, researchers found that many communities tend to emphasize physical symptoms over psychic distress. “They recognize their emotional distress, even if they do not readily present it as a symptom to doctors,” authors wrote. “Thus, patients medicalize their suffering but tend not to psychologize it (Tran, 2016). For them, the emotional distress is certainly related to symptoms such as insomnia or headaches but is not to be treated medically.”
According to this 2008 research, poor adherence to major depression treatment tends to be more frequent among Latinx patients compared to the general U.S. population. In the study, participants reported that they believed antidepressant medication was only meant for “severe” cases. It was also commonly feared as a potential gateway for drug addiction—a common misconception with separate connotations related to negative perceptions about Latinx culture.
What one participant said:
“Muchas de las personas piensan por el hecho de estar tomando medicamentos antidepresivos es como las personas que toman cocaína y todas esas cosas, que van a estar así.”(Many people think that because they are taking antidepressant medications, it's like people who are using cocaine and all those other things, that they're going to be like that.)
Some Latinx individuals also believe that taking medications categorizes people as floja (weak), inutil (useless) or chiquitita (small) — characteristics that “violate this fundamental lived value of being a hard-working person who struggles to overcome problems.”
Among Iraqi immigrants living in Michigan, about 37% in this 2016 study did not adhere to their antidepressant treatment. Researchers noted that those who did not stick to the medication were more likely to be in poorer health compared to the previous year.
A study based in Sweden found that immigrants born in the Middle East and other countries outside Europe had lower primary medical adherence to antidepressants. Authors suggested a few possible explanations: cultural stigma, language barriers or low trust in Swedish health care.
African Americans (both immigrant and native) are also likely to mistrust a health care system with a history of longstanding inequalities—especially when it comes to potentially being “experimented with” via medication.
Before I tell you about my own experience with antidepressants, I want to offer a disclaimer: There is absolutely no “one size fits all” treatment plan when it comes to depression. Research shows depression is caused by a combination of multiple factors (genetic, environmental, psychological etc.) If you keep in mind that no two brains, bodies or life experiences are exactly alike, it shouldn’t come as much of a surprise that our experiences with medication vary, too. But if antidepressants are part of your recommended treatment plan, please don’t let stigma or fear keep you from potentially life-altering care.
I’ve been on fluoxetine (or Prozac) for a few years now. The first time my parents suggested I get on the medication, I was recovering from ongoing suicidal ideation. In a way, my family and I were desperate for a cure-all to the boulder-like weights glued to my shoulders. At that point, I didn’t have room for pill shaming or fear. I just needed to be able to fall asleep without secretly hoping I wouldn’t wake up.
I need to make a point here to say that I should have been on antidepressants for much of my life. For as long as I can remember, I’ve been uncomfortably emotional and uneasy about, well, everything. And even when I was a kid, I had trouble imagining myself growing older. I might put up a front if we don’t know each other too well—and, honestly, even if we’re best friends. I’ve never been good at seeking help, despite being head over heels in love with and trusting of the people I choose to let into my life. There’s a lot behind the why, but for now, all I really want to say is I should’ve opted for medication long ago. It should not have been any kind of “last resort.”
Anyway…
Unlike Ilene, my folks (also physicians) seemed much more comfortable scribbling down the name of an antidepressant than they were when my brother and I mentioned psychotherapy. It’s as if they either inherently believed or wanted to believe my pain could be “solved” using a mathematical equation; find the perfect little dosage and all is well. A quick fix. Or at the very least, a guaranteed fix.
I was on fluoxetine without counseling for a few weeks before I started noticing a difference. It’s not that I was magically happy all of a sudden. It was just a little easier to make it through the day. I didn’t constantly run to the bathroom to break down with every news alert of a school shooting, a suicide, a travel ban. I felt it. I did the work my newsroom needed me to do. I moved on.
The medication turned the intensity down a notch, helped regulate my mood a bit and offered just enough clarity to be able to see into tomorrow. The high highs and low lows straightened out, and I started going through life with this dull white noise machine playing in the background.
But I knew that couldn’t become my normal. What I was lacking was enthusiasm, joy, desire. And that’s when I decided to seriously consider counseling.
In a way, the fluoxetine planted the seed or the thought of regaining some kind of control, or at least a fleeting desire to want to be in the driver’s seat again, headed somewhere. But honestly, it took coupling the medication with weekly therapy for me to really flourish again.
I still have bad days, of course. Really, really bad days. But it’s different. I don’t see a bad day and immediately think of an end. I see a bad day and am able to push myself to think of it as a momentary increment of time, a minuscule segment of something much bigger. And when I say I want to just sleep things off, my head falls to my pillow with the intention of rising up again.
I Need Medication to Treat My Mental Illness. Why Can't People Accept That? (Maria Yagoda, VICE): Maria Yagoda is used to strangers recommending she try yoga or meditation instead of taking medication for depression and anxiety. A decade into treatment, she’s learning to tune them out. “Having a mental illness is already hard enough. But then to face this routine resistance to its medical treatment makes me, and others, want to be quiet about this stuff.” Read here.
9 Women on Their Experiences With Antidepressants (Tessa Miller, The Cut): The Cut asked nine women about their experiences with antidepressants, why they choose to take them, the pros and cons of medication, and the biggest misconceptions about mental health treatment. “The meds allow me to get out of bed — to have the same hope others wake up with naturally — while suffering from severe depression.” Read here.
All I Want for Christmas Is Zoloft (Jessica Valenti, GEN): This ode to Zoloft—er, personal essay—takes a feminist look at how women are made to feel “as if we need to suck it up” when we’re struggling. “For me, funnily enough, starting medication ended up feeling like a feminist win.” Read here.
My Mental Illness Did Not Prevent Me From Succeeding, But The Stigma Nearly Did (Michelle Yang, Huffington Post): Michelle Yang begged her parents for treatment for months, but as Asian American immigrants, they “misguidedly feared a mental illness diagnosis would tarnish my permanent record, ruining my chances at college,” or worse, any potential marriage prospects. Even years after being hospitalized and diagnosed with a mental illness, Yang’s family tried to stop her from taking medication. Read here.
Thank you again to Ilene for sharing your story—and to Marissa (that art!) + editing champ, Farah, for contributing your talents.
What did you think of this issue? Did anything in particular stand out? Tell me in the comments or send an email my way.
—Fiza
Foreign Bodies is an email newsletter centering immigrant and refugee experiences with a mission to de-stigmatize mental illness through storytelling. It’s written and curated by Atlanta-based writer Fiza Pirani with copyediting and fact-checking help from Boston-based journalist Hanaa’ Tameez and traveling journalist Farahnaz Mohammed. Want to contribute your time or share your own #ForeignBodies story? Fill out this form and be sure to say hi on Twitter @4nbodies or Facebook. Special shout-out to Marissa Evans for Issue 15’s art and Carter Fellow and friend Rory Linnane for our adorable animated logo!
If you're thinking about suicide or worried about someone who might be, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255) or text 741741 to connect to a crisis counselor in the USA. You can also find a wealth of culture- or language-specific recommended resources on our site, foreignbodies.net.
sent this to my mom!