Taking Meds Will Make Me Fat: risks to life and self in the therapy space

A word of caution, I deal with suicidal ideation in this post.

This post has been brewing in me for a long time and I don’t know why it’s taken me so long to write it. I think I have been in some sort of denial that this has been happening, is happening, KEEPS HAPPENING in the little sacred space of my office. I’m a Registered Psychotherapist. That is a designation specific to Ontario and it’s equivalent to Licensed Mental Health Counsellor in the states, or Registered Mental Health Counsellor in some other jurisdictions. It is a profession that focuses exclusively on the clinical work of talk therapy. I don’t diagnose people and I don’t prescribe meds, but after 21 years of practice, I have acquired a pretty extensive familiarity with the kinds of mental health issues that benefit from the assistance of medication. I like to say I’m “neutral” about medication in most situations. Many clients have benefited and some clients have not. Some clients have found meds to be more trouble than they are worth. Some clients have been manifestly overmedicated to the detriment of their capacity to function.

However, I’m not talking about any of that today. Today, I want to take you through an experience I have had and continue to have and continue to feel flummoxed and enraged and devastated by. There’s more than a few podcasts out there these days that take you inside the therapy space to hear what is really going on. This is going to be kind of like that. It isn’t any particular client obviously, I don’t have permission to talk about them. But it is an amalgam of experiences that resonate on the same frequency, that convey the same message and impact. If you are a client reading this (I mean, you might be, this is a public blog) this is emphatically not actually you, but if it is like you, maybe you can hear me in a way that you haven’t yet. Maybe the anguish and frustration and fear I have about the collective you that I’m writing about may penetrate in ways it can’t when we are together. I hope so. Because I’m worried about you.

Most often, this therapist/client relationship is pretty substantial. We’ve known each other for nearly a year and often more than that. We might be of a similar age or maybe a decade or two apart. You (client) have come to see me because of a pain, a grief, a stress or a loss. You have been confused about your direction or your worth. Maybe you have a story in your past that speaks of violations of trust and betrayals of compacts of care. Maybe the world as you knew it is suddenly upside down and you don’t know where you fit or if it’s entirely your fault anyway. There’s a lot of ways to get to this state but you felt pretty bad and you made the call.

We’ve been working together and I am coming to know you and your story. We see the patterns, how they were formed, how they are alive in your life. If we are lucky, they have been alive between us and we’ve been able to do something different with them in those moments. Always, I am listening, trying to know and trying to understand your story, your perspective, your pain and your strivings. Everyone who comes to see me is striving for something that feels like safe connection, a place to lay your head and not worry about your right to exist. Much of the time, my particular brand of listening and noticing and compassionate presence is enough to comfort and shift. Every single one of you is working so hard to feel better and all of you use me in the ways that you can to make that happen. I am right there with you.

Sometimes, that pain doesn’t move. We talk and reason. We know the whys and the whens and the hows. But every time you leave my office, and sometimes even when you are right in front of me, the feelings rise up and overwhelm you, dragging you back to a hell I can’t touch. It’s a despair so profound or a fear so gripping that you feel like you would rather be dead, sometimes actually, you would rather be dead. You think about how you are a burden and a trial and list the ways people would be better off without your troublesome self causing trouble and that the very fact of this ineffable pain is the reason enough to go. No one, including you, should have to deal with this shit.

Around that time, while staying with the reality of your experience, I am starting to wonder whether it’s time to explore more support. We are usually traversing a very difficult landscape together but you keep slipping into crevasses and slipping out of whatever anchor to the surface the therapy has been providing. I’m thinking, perhaps it’s time to explore medical assistance in the way of medication? I explain it as a tool to help regulate so you can do this hard work of unravelling the past and the way it lives in your present. I explain it’s a medium or long term support and that you can do this with your own agency at the forefront. I explain that there is no shame in asking for more help and perhaps you need more than I can give you, just me for an hour a week. When your system is so chaotic/activated/imbalanced, you can’t see the path through the dust and static. You can’t really hear me or connect with me. I don’t want to lose you.

You look up and say, “I don’t want to go on meds, I will gain weight”.

How did this happen? How did you come to a place that tells you that the possibility of weight gain means you need to die, or feel like dying for half your life, or lose your partner, or your job, or the connection to your kids or your friends? How is the imperative to stay small more important than the possibility of feeling well, of expanding into your possibility, of making the world better with your glorious and grounded presence?

Now, I know the answer to this. I know how it happens but what I’m trying to do here is capture how f-ing absurd this twisted trap of fat-shaming, body controlling, garbage really is. I have actually had people tell me that the possibility of gaining weight means they will continue to suffer so profoundly they might just kill themselves soon or maybe later, but eventually possibly. They don’t want to suffer. They want to feel better. Like I said before, they are all working so hard and they will work harder and harder and harder and wonder what else they can do. They will cry inconsolably, fall apart at work and at home, hide from the world, endure psychic and physical pain that is unabated and do all of that instead of trying a medication that may result in weight gain. And the collective response of the rest of us is far too often, “oh yes, we wouldn’t want that”. Doctors lead with this in their description of the side effects, “I need to let you know, you might gain weight”, with a knowing tone of “I will understand if you don’t want to take it because my gosh, gaining weight is so much worse than waking up and feeling like you want to vomit every morning and you can’t leave your house. I know Agoraphobia is hard but at least you still fit in your pants.”

Alright, so no doctor is going to say that, I hope, but how many are complicit in reinforcing this kind of logic? Lots of them. I have heard the stories, I have experienced it first hand to be honest but you know what? I TOOK THE DRUGS AND FELT BETTER.

Medication is not the only solution. It doesn’t solve the crushing weight and cognitive load of poverty or racism. If this society could wake up and take those things more seriously, maybe starting with a universal basic income, that would help. The existence of meds doesn’t absolve me of working towards a better world with you. It doesn’t cure PTSD. It doesn’t even really make you feel good. But you might feel less bad and the worse you feel to begin with, the more likelihood that it will make a difference you can feel. When you get some ground under your feet, you can come to therapy and have some psychic space to let the magic of that work unfold. What I want most is for you to believe that it is better to be in the world 30 lbs heavier, with more connection, resilience, contentment, expansiveness and satisfaction, than it is to be skinny and a husk of a human or possibly a corpse. I further want to rest of the world (I’m looking at you Fam Docs) to really think that too and work to make that true.

Fat shaming, fat phobia, body policing are killing us in so many ways and this is one more. I’m just going to keep doing what I can to counter it I guess. But what I really want is for all of us to cease being complicit in this system and tell everyone it is okay to just be happy and okay to be fat and best to be both if that’s what you are and that you love them and want them to stay and be.