As is true with any newly popularized term, the term “evidence-based” has an almost intuitive ring of credibility to it. It brings to mind images of tree-lined and stately buildings fronted with Grecian columns and filled with persons wearing white coats, speaking in hushed tones, and offering reassurances. But this ring may be hollow. As Montaigne noted, “Nothing is so firmly believed as what we least know,” and as Valery warned, “That which has been delivered by everyone, always and everywhere, has every chance of being false.” [Source]

That doesn’t sound like your typical first paragraph of a peer-reviewed research article, now does it.  No, the period in lieu of a question mark is not a typo – I’m being rhetorical.  Because no – clearly no – it does not.

It’s maybe the most foundational question of dealing with a mental health diagnosis – should I take medication or should I not? And, for better or worse, in our modern era there are plenty of both teetotalers and psychonauts from whose experiences we can draw near-infinite conclusions, confusingly – and with unfair or difficult complexity – in direct contradiction with one another in their support of both sides of this argument.

When dealing with situations like this – to be or not to be, so to speak, even outside of the MH sphere – I try to stick with two domains; first, myself, my own personal experience, which has utility as far as I as an individual is concerned.  Second, any useful ideas or results we might be able to glean from our group experience as a whole, with an understanding that there will always be exceptions to accurate research, well-meant but fallacious advice, and (my least favorite) straight-up malicious disinformation.

In starting with the second domain – what we understand by stepping back and considering mental health as a field unto itself, populated with data points drawn from myriad individuals (both afflicted and prophylactic) – we get the general position of medication is good and to recover you will need to take medication for the rest of your life. There is both comfort and despair here in that the possible solution cannot be dissevered from the notions of permanent and disease. As you might have noticed, we at CBTN aren’t even fans of the word “illness,” let alone permanency in the context of mental health.

What the medical field has done here (if we give them the benefit of the doubt) is collectively subscribe to the conservative approach. And, mind you, this is synonymous with the wise approach, and we ought to be thankful MH professionals exercise wisdom. What gets lost in this generalization, however – the idea of needing medication always and forever (Napoleon Dynamite?) – are the answers to legitimate questions like what qualifies as medication and who is the arbiter of so deciding these qualifiers, and what are their motivations?

YOU NEED MEDICATION ALWAYS AND FOREVER!

Many MH professionals I know – and we’re talking PhDs and PsyDs and MDs – dismiss these questions, sometimes even at their patients’ or clients’ expense (“There’s your paranoia again – TOLDJA!) This situation gets very tricky, because if we’re being fair they’re not always wrong. Scripp paranoia is and does indeed happen by the fault of the patient under the influence of legitimate mental health problems. But that’s but the tails side of the MH coin, and even the most amateur student of history can point out its obverse – that word physicians love to hate – malpractice.

“There are as many definitions of what constitutes “evidence” as there are definitions of what constitutes a “service.” More important, the use of the term “evidence-based practice” presupposes agreement as to how the evidence was generated, what the evidence means, and how or when the practice can be implemented.” [ibid.]

What qualifies as Medication?

MEDICATION noun
[med-i-key-shuhn]
1. the use or application of medicine
2. a medicinal substance; medicament

Seems a bit circular, dear Watson. And indeed it is, and for good (logical) reason – what constitutes a medicine as it might differ from a drug is as simple as this:

SOMEONE JUST SAYS SO.

As the doctors of old used blood-letting, then cocaine, then [insert horrible mistake here], keep in mind the doctors of now will sure-as-you’re-born inherit that honor in the history books of tomorrow. This isn’t to say modern medicine was birthed from bovine digestive tract – more simply and generally, it’s always useful to be mindful that this stuff comes from humans and is legitimized by humans, not by its actual efficacy.

And that is precisely why smart people (and i.e. good MH professionals) consider efficacy – how well it works or how much tangible benefit it creates – when defining and understanding medication.

In regards to who is the arbiter of so deciding these qualifiers, we can objectively say the responsibility lies with the American Psychiatric Association (the architects of the Diagnostic and Statistical Manual of Mental Disorders, current iteration DSM-5 – and that we’re on version 5 already ought to remind you of its ridiculousness); if you care to shine a light into cave these orcs hide in, you can meet the individual members of the APA Board of Trustees here What are their motivations? I hate to be cynical, but I suspect it rhymes with money, power and control – if we re-define “rhyme” as “exact fucking words.”

Which, to the point, we have every right to do (re-define, that is) – and to do it correctly (for the cheap seats) we ought to base it on whatever is most efficacious. You might say defining what constitutes a medicine by its efficacy is precisely what makes a MH professional efficacious.

So in looking at “medicine” two ways we are usefully served by the dual definition:

MEDICATION noun
[med-i-key-shuhn]
1. any substance used in an attempt to change any situation for the better
2. particularly any substance that both fits (1) and has actual efficacy

So how do we define “efficacious”; what is our metric for “IT WORKS”?

As with the medical field’s moronic method of defining medicine, so to it struggles to define efficacy:

“Much of what passes for research on evidence-based practice in the field of child and adolescent mental health might more aptly be described as clinical treatment efficacy research…” [ibid.]

As we did with medicine, so too can we understand efficacy in two ways, by appreciating two domains:

  1. Does it make the patient feel better?

This isn’t rocket science – it’s as binary as it gets. Substances (medications, as we’ve re-defined them) that fall under this first efficacious umbrella include alcohol, marijuana, and cocaine as well as plenty of legal substances. Keep calm – many of these do not reconcile in the second domain, which ought to be understood as:

2. Does it actually make the patient better?

In this domain we need to consider a number of nested double-definitions, including:

2a. Short term/Long term (obviously railroading cocaine thrice minutely doesn’t have long term efficacy)

2b. Length of life/Quality of life (what constitutes better?)

2c. Individual benefit/group benefit (who/what is the object we most benefit from benefitting?)

You don’t need your hand held, and eat your heart out down that road trip should you so desire. The key difference we’ve highlighted is (1) – Does it make the patient feel better? If the answer to this question is yes – even if only for a moment, as with most illegal substances – that, ladies and gentlemen, ought to be understood as a medication. And, to pursue the focus of this article to its logical terminus, ought to evince the fundamental truth that your ass is on medication no matter what you do.

The battle you face, O teetotaler slash psychonaut slash yes-you-too-normie, is developing your faculties of decision-making and choice in general to control which medications you allow yourself to get addicted to. Help me out a bit here and understand that these include food, sex, video games, politics, workaholicism, social justice, marine biology, GI Joe PSAs…

As David Foster Wallace once said – and I’ll put the full video below, but to end with the singular point –

“We do not get to choose whether we worship. Everybody worships. All we get to choose is what we worship.”

Likewise we don’t get to choose whether we take medication. You’re on medication, bro. Sis. Cis (whatever). What you do get to choose is what medication you take.

I try to stick with water.

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