Elizabeth Gilbert, you suck.

[rachelmanija]

From that book that I finally got around to reading for research purposes (research question: "Why is this book such a huge bestseller?") and which everyone but me loves to bits, Elizabeth Gilbert's Eat Pray Love. Context: During a harrowing divorce, Gilbert becomes depressed. She tries endless "natural remedies," but seeks the care of a psychiatrist after she attempts suicide.

I do know these drugs made my misery feel less catastrophic. So I'm grateful for that. But I'm still deeply ambivalent about mood-altering medication. I'm awed by their power, but concerned by their prevalence. I think they need to be prescribed and used with much more restraint in this country, and never without the parallel treatment of psychological counseling. Medicating the symptom of any illness without exploring its root cause is just a classically Western hare-brained way to think that anyone could ever truly get better. Those pills might have saved my life, but they did so only in conjunction with about twenty other efforts I was making simultaneously during the same period to rescue myself, and I hope to never take such drugs again.

There are so many selfish, condescending, and hare-brained statements in that one little paragraph that I need to pull it apart to address each one.

But I'm still deeply ambivalent about mood-altering medication. I'm awed by their power, but concerned by their prevalence. I think they need to be prescribed and used with much more restraint in this country

In the year 2020, approximately 1.53 million people will die from suicide based on current trends and according to WHO estimates. Ten to 20 times more people will attempt suicide worldwide (2). This represents on average one death every 20 seconds and one attempt every 1-2 seconds.

It is, of course, possible for a medication to be over-prescribed in some cases and under-prescribed in others. But considering that, according to WHO, "Suicide is among the 10 leading causes of death for all ages in most of the countries for which information is available. In some countries, it is among the top three causes of death for people aged 15-34 years," I'm going to say that under-prescription is the bigger problem-- a problem which attitudes like Gilbert's foster.

I think they need to be prescribed and used with much more restraint in this country

How callous, priveleged, arrogant, selfish, and smug can you get?! So meds are okay for her, because she had a real problem and didn't take them until she was at the point of suicide and has moral qualms about their use, but all those other ignorant peons who gobble them like candy need to have their access restricted?!

That is one of the most despicable statements and sentiments I've come across in quite some time.

and never without the parallel treatment of psychological counseling.

I agree with that, actually.

ETA: Oops, missed the "never;" I think counseling should always be offered, but should not be mandatory. If nothing else, the experience of having a mental illness for a long period of time will usually give you dysfunctional thinking patterns and ways of relating to people that counseling will help address. But if your problem is being completely addressed by meds and you're doing fine, no, you probably don't need counseling if you don't want it.

Medicating the symptom of any illness without exploring its root cause is just a classically Western hare-brained way to think that anyone could ever truly get better.

1. In many cases of mental illness, the "root cause" is either known as a biological and/or genetic problem and so doesn't really need to be "explored" in the sense of discovering its root cause (like schizophrenia or bipolar disorder) or the patient is so ill that she will not benefit from such exploration until medication has kicked her into a higher-functioning mode.

Also, some forms of talk therapy are specifically about the present and not root causes -- and those forms are statistically more effective for some disorders than classic "root cause" therapy. (ie, cognitive-behavioral therapy vs. psychoanalysis for depression.)

2. What a stupid statement!

"Medicating the symptom of a broken leg by setting it without exploring its root cause is just a classically Western hare-brained way to think that anyone could ever truly get better."

"Medicating the symptom of the bubonic plague with antibiotics without exploring its root cause is just a classically Western hare-brained way to think that anyone could ever truly get better."

"Medicating the symptom of a cataract with surgery without exploring its root cause is just a classically Western hare-brained way to think that anyone could ever truly get better."

3. Gilbert's Asia-philia blinds her to the reality of actual Asian medicine, which is not necessarily as holistic as she thinks. She should read Atul Gawande's Better for an excellent portrayal of actual doctors in India doing brilliant work under extremely difficult conditions.

Those pills might have saved my life, but they did so only in conjunction with about twenty other efforts I was making simultaneously during the same period to rescue myself,

I am absolutely not against doing whatever might help. All the same, the plural of anecdote is not data.

and I hope to never take such drugs again.

Well, I hope you DO!

I can't believe I'm wishing such ill on anyone, whatever sort of scumbag they are... but this book was a huge bestseller, people are influenced by what they read, and so Gilbert's screed may be indirectly responsible for someone committing suicide because they were trying to make sure they waited to use them as long as she did -- and she waited till it was down to her, a knife, and a worried friend. What if some reader doesn't have a worried friend?

What a loathesome and damaging thing to write.

Here is a three-part essay on my experience with depression.

Here is a three-part essay on my experience with post-traumatic stress disorder.

Comments

[leiliaxf.livejournal.com]

yeah, I thought that her take on depression was a bit flippant, to say the least.

I also found her hippie-dippy "ooh, I'll go to India and find myself" a bit much. I more or less eye-rolled through that section.

<--thankful for Paxil and all it's done for me...

[lady-ganesh.livejournal.com]

::downing her Zoloft and agreeing::

[machineplay.livejournal.com]

Well, there's a book I'm glad I missed.

and never without the parallel treatment of psychological counseling.

I disagree with this quite a bit, actually. Never without regular consultation with someone who knows something about mood disorders, sure. Messing about with the brain should be taken seriously, and should be tracked and evaluated on a regular basis.

However, I don't think that diabetics require counseling to take their insulin. Likewise, someone with a chemical disorder of the brain that is alleviated by taking medication shouldn't require more than a regular schedule of meeting with the prescribing doctor for more than 5 minutes at a time, with that schedule to be determined by that person's mental state and their familiarity with the medication. I think that the idea of mandatory counseling, as opposed to consultation and observation, and pushing the idea that medication can't work without counseling drives many people away from getting the medication they need. And, I don't feel that counseling is necessarily the key to discovering when a medication is going wrong.

Not requiring counseling is not the same as saying someone doesn't need counseling. I feel that counseling should be far more accessible and people should be better educated in how to make the most of it. I think we can agree that the world is swimming with people who need counseling (see: Ms. Gilbert, above), whether they're in need of medication or not. That shouldn't prevent someone from receiving theraputic medications, nor should counseling sessions alone be considered adequate for ensuring that powerful medications are having the appropriate effect.

The rest, you get a *hands up* for; I couldn't agree more, and the woman sounds like a sanctimonious twit.

[rachelmanija.livejournal.com]

Ack, missed the "never." I basically agree with you, though I think that the experience of having a mental illness for a long period of time will usually give you dysfunctional thinking patterns and ways of relating to people that counseling will help address. But I'm going to ETA the essay accordingly.

[janni.livejournal.com]

I was about to post my agreement on the "in conjunction with therapy" part, too.

Of course, therapy is often harder to get access to than a prescription in this country. But when you can get access--antidepressants actually can give one the mental space to work out some coping skills--which may or may not involve looking at root causes, though, because not all coping skills are about root causes.

Last I checked--which was a decade ago now, come to think of it, so may be dated info--antidepressants were faster than therapy, both were equally effective over the mid-term after that, and therapy tended to be better at reducing future episodes over the very long term.

They're both needed tools, which she doesn't seem to get. But I would like it if no one went home with a prescription without also being handed a therapist referral. Because it may be a purely chemical issue--or there may be issues or ways of thinking that, if you look at them now, can help make things better later. Because, you know, everyone is different. Which it's also not clear she gets.

[lady-ganesh.livejournal.com]

My insurance company paid for therapy for about six months. It's still paying for my meds. Yay meds!

[tammylee.livejournal.com]

I'm glad I missed that book.

I was put on a month's prescription for anti-depressants while I was overcoming a vitamin deficiency that caused severe depression. I certainly didn't need psychological counselling; just regular doses of the vitamin I was deficient in.

Sweeping statements like the ones she made are misleading.

[yhlee.livejournal.com]

Screw not wishing ill. The idiot who wrote that book is cordially invited to come greet my spork.

[marith.livejournal.com]

*applause*

I have several friends who suffer from depression but refuse to consider medication, precisely because of sentiments like the above. It's painful to watch.

[teratologist.livejournal.com]

Gilbert's attitude sounds eerily like the old "well, it was ok for me to get an abortion, because I really needed it, but I disapprove of those sluts who use it as birth control and don't even feel bad afterwards" line.

[rachelmanija.livejournal.com]

It is! It's exactly like that.

[vom-marlowe.livejournal.com]

OMG I hate her so much.

A dear friend lost her brother because he stopped taking his pills.

[meganbmoore.livejournal.com]

...

Wow. You know, even though the issues there are obvious even at a quick read of just the paragraph, my first thought was "people can read an entire book with a narrative written with that much ego?"

[wortschmiedin.livejournal.com]

I agree. There is just one thing I want to mention. I am currently taking anti depressants, but I had a close thing to a perfect childhood, a suppoertive but not crowding family a great husband and great kids. I have a decent job and little worries. And I am suffering from depression. I am currently in the process of deciding if I indeed need the flanking therapy. I have a great counsilor but at the same time I feel like I am wasting my time. And this applies strictly to me. I Guess the point I want to make is: It can hit anybody. It is the result of too much stress in too little time to cope and some other issue which may or may not me adressed by therapy. People like that writer are the reason why I truly believe That nobody should be empowered to make decisions FOR somebody else, unless he or her actually has been empowered and even then I advertise caution, because that person is the only one who has to live with those decisions. They should at least be his/her own. Am I making sense?

[dichroic.livejournal.com]

That's difficult, though, because someone severely depressed (or manic, in bipolar cases) isn't always capable of making their own decisions well. Antidepressants may be one way of getting someone to the point where they can make sound decisions.

You're making sense, but I think it's a delicate and difficult balance.

[tonapah.livejournal.com]

I think they need to be prescribed and used with much more restraint in this country, and never without the parallel treatment of psychological counseling. Medicating the symptom of any illness without exploring its root cause is just a classically Western hare-brained way to think that anyone could ever truly get better.

Delurking because this makes me so angry. How does she propose people pay for therapy? My insurance, like many, refuses to cover any therapy, and these sessions aren't cheap. Is she doing something other than preaching at people about what they should do? Is she lobbying for change in the health insurance industry and for recognition of mental illness as an illness that deserves coverage? It's really hard to get a lot of people into therapy for a variety of reasons, including financial ones---effective drugs are certainly better than nothing.

[sartorias.livejournal.com]

*Clapping hard*

sometimes that reasonable-sounding tone over the "What's good for me should be good for you, and if it isn't, you're at fault!" message can be more destructive than rug=chewing rants.

[sleary.livejournal.com]

Translation: I'm glad help was readily available for me, but I think it should be really damn hard for everyone else to obtain because I am a special, special snowflake.

[ladiesbane.livejournal.com]

What a relief! A dear friend pressed this dud on me with great praise, and it was all I could do not to wing it against the wall.

My pinnacle gripe was that this was a masturbatory journey of wealth and privilege, a vacation to wallow in her rich, creamy inner self. This should have been called, "Eat, Pray, and Love Myself To Death."

(I could go on, but I'll spare you. And since I'm delurking briefly, I'll add loud cheers to what you said, without getting started on my mental health rant. And I look forward to your posts -- always interesting.)

[faithhopetricks.livejournal.com]

AHAHAHAHA

I HATE THAT BOOK
SO VERY, VERY MUCH

WHEN I WORKED IN THE INDIE BOOKSTORE I USED TO TRY TO ENCOURAGE PEOPLE TO BUY 'THREE CUPS OF TEA' INSTEAD

[rachelmanija.livejournal.com]

Spork it! Spork it for me!

[epj.livejournal.com]

Wow. Amen to you and a big shut the hell up to Elizabeth Gilbert. I am hearing more and more lately that antidepressants are "overprescribed", and I think it's just absurd. Generally, when I pin people down (people I know/see, obviously not Ms. Gilbert), they're talking about people being put on antidepressants for reasons other than medical depression. You can quibble about those folks all you want; me and my major depressive disorder will keep taking our Effexor every day and thanking God for it.

[tibicina.livejournal.com]

People are prescribing antidepressants for reasons other than depression? /Why/? I mean, other that the zoloft/wellbutrin (it's an antidepressant/it's a anti-smoking drug) thing, what are benefits? Most of them have side effects that I wouldn't want if I could avoid them.

[wordswoman.livejournal.com]

I got through the book but found her so irritating as a narrator. She's so damn smug about herself, and so certain that she's Miss Lovable Popularity. I don't think I'd want to know her in real life.

[clodia-risa.livejournal.com]

1) I have been on antidepressants, but stopped mostly due to trust issues with my psychiatrist and some physical side effects which my psychiatrist brushed off.
2) I have had therapy, but that stopped when my therapist stopped answering my calls (true story!).

What I hear from this woman is the last thing any person who has a mental illness, especially depression, needs to hear: "I am a special special snowflake, and unlike me most people don't really have depression, they just have issues." What else can she mean when she says that people in this country are over-medicated and ought to have a lot more therapy?

I know, I'm paraphrasing a little, but this feeds into the idea that with enough hard work one can overcome your issues - but for me, at least, it's the inability to put in that hard work that is the issue.

[jeremytblack.livejournal.com]

Wow, such anger, Rachel. Clearly you need meds. I mean, er.... Therapy. Clearly you need therapy, that's what I meant to say.

Never heard of the book, but this is the same as the people who don't "believe" in ADHD and such. It's always more fun to be able to say "tsk, tsk" than to think, I guess.

[oursin.livejournal.com]

I am always annoyed when people diss certain solutions to problems as 'sticking plaster' - because while there are some situations in which sticking plaster may b e inappropriate, in many others it will actually stop problems getting worse at least, and may even contribute to healing.

And wittering about 'root causes', when these may be huge inchoate social factors, and when you can do something useful to alleviate the condition in an individuals - as in, okay, you do something to eradicate the rats and their fleas, but you also treat the individuals who actually already have bubonic plague - bah, and ugh, and general codslappiness.

You say codfish, I say parakeet

[rachelmanija.livejournal.com]

Exactly. I particularly hate the idea that individuals have to personally address the root causes... via navel-gazing. If the root cause is, say, lack of access to health care, the solution to the root cause is political action, not haring off to an ashram in India. I note that Gilbert never even mentions political action, although she talks a lot about what I see as highly political issues.

And as you say, you can't hold off on fixing the problems of individuals because you're waiting for the revolution.

[panjianlien.livejournal.com]

Ya know, I am highly skeptical about psychiatric medications, as a result of having once been prescribed one -- in a situation where it was not, as it turned out, necessarily indicated that I be medicated at all -- and ended up having a drug reaction that consisted of grand mal seizures.

And on the whole, yes, I do think that certain drugs, and classes of drugs -- many SSRIs, sildenafil citrate (Viagra), statins (HMG-CoA reductase inhibitors like Lipitor), to name just three -- are vastly overprescribed. Indeed, there's plenty of proof that many doctors are being given fat incentives to prescribe certain drugs regardless of whether they are indicated.

BUT.

I would sooner deprive my mother, a kidney transplantee, of her anti-rejection medications than take away psych meds that have even a prayer of working from people with clinical mental illnesses. Because my mother has another therapeutic option (surgery & hemodialysis), however poor its long-term viability. People with clinical mental illnesses don't have any other therapeutic option that has any legitimate success rate at controlling their symptoms.

Talk therapy's great for a lot of things, presuming a smart and skilled therapist and, y'know, that little thing called access to therapy. But it doesn't do shit for neurochemistry.

Eat, Pray, And Be An Overindulged Rich Self-Centered White Lady pisses me off for so many reasons.

[rachelmanija.livejournal.com]

Did you read the book too? Wow, did it make me hate her!

[trasnochadora.livejournal.com]

After this hateful bullshit and Stephenie Meyer, I am beginning to doubt the caliber of New York Times bestsellers.

[lady-ganesh.livejournal.com]

You didn't when The DaVinci Code was doing well?

[wordweaverlynn.livejournal.com]

Thanks. Linked.

[umbo.livejournal.com]

You rock.

[gramina.livejournal.com]

I agree with the whole thing -- I just wanted to pull out this line and say it made me snort: the plural of anecdote is not data. I love that, and I may be quoting it-- !

[rachelmanija.livejournal.com]

Not my line, I'm afraid (and I don't know whose it is) but it's a good one.