Why exploring polyphony around medication is so important – inside and outside of Open Dialogue
There are many things that are important in dialogues around medication for mental health. In this blog post I’m going to focus on the many voices that exist in people and between people on this topic (known, in Open Dialogue, as polyphony). This is an unashamedly person take on the subject. As always, I hope it promotes thought and dialogue. When reading it, please remember that each person’s relationship with medication is unique and what I write here isn’t intended to speak for others. If you find something in these words that relates to your own journey, the journey of a loved one or of someone you’re trying to support – great. Talk about it, if you can. The more authentic dialogues we can have around medication, the better.
First things first. I take psychiatric medication and I do so for lots of reasons. I take what is often referred to as an antipsychotic and an antidepressant. I do not take them to treat and illness as, within my framework, I do not believe I am ill. I use them to help provide a buffer between me and aspects of life that trigger my voices, visions, intense beliefs and crushing lows and make them hard to navigate.
I haven’t always taken medication. I spent almost a decade (from 2009 till the birth of my child) not needing to use it. I had voices, visions and times of distressing beliefs in this period – but I was in a position to work through it in other ways. I had more space back then (I wasn’t a parent, for example) and the world didn’t feel so painful to live in. There will be times in my future when I decide to withdraw from medication once more. I am not more virtuous or ‘well’ when I don’t take medication. I’m just in a position to use other strategies to live this thing called life.
The use of psychiatric medication is an area of polarised and fraught debate in many arenas. Some will say that I have ‘insight’ at the moment and am doing the ‘right’ thing. Others will say that I’m brainwashed by psychiatry and that I was doing better when I wasn’t taking medication at all. In amongst these debates and strong positions it can be hard to untangle one’s own relationship with medication. Shaped as they are by the relationships that we live in – they can be complicated and emotive.
I still have many different voices within me about my use of medication, lots of polyphony. Yet, today I want to focus on a time when my relationship was more fraught, and I found it hard to talk about it. I hope in doing this I will highlight some of the ways Open Dialogue (done well) can help people explore and untangle some of the complexities and make an informed choice about what they want to do at this particular point in their lives.
When I was in my 20s, I was taking high doses of an antipsychotic, an antidepressant and a mood stabiliser. I slept A LOT. I had other adverse effects too but would rarely speak them out loud. When asked about them, I’d acknowledge the sedation but gloss over everything else. There was a part of me that was scared that if I talked about the bad parts of taking medication I’d have to go through the difficult process of swapping to another drug, a process that I was particularly sensitive to and had caused many crises. I was comfortably uncomfortable on it, in a way. I didn’t particularly want to talk about it because talking meant making changes and changing medication was hard.
Every so often a crisis would punctuate the calm. I’d usually end up admitted to the mental health unit and admit that I’d ‘forgotten’ to take the medication. I’d be gently, but firmly, reminded that medication is important. We’d talk about strategies to help me remember to take it – dosset boxes and putting the pills next to something I routinely do in the morning, for example. Yet, despite our best efforts a few months later I’d stop taking the pills and end up in crisis all over again. Many of my 24 admissions went along this pattern. Once the medication was reinstated things would calm down and everyone agreed I just needed to take it regularly.
The volume of things that were left unsaid during these times is deafening. I badly needed someone to sit down alongside me, slowly build up my – depleted – sense of trust and help me explore how I felt about taking medication. Underneath the compliant veneer was a whole host of feelings, worries, questions and hopes that were tangled up together with the act of taking a tablet. I could have talked about the way I was first introduced to antipsychotics and how that shaped my ambivalent relationship with them. I could talk about my fears about the monster I believed the medication helped me cage (that thing I’d learnt to call schizophrenia). I could talk about the impact of sleeping through the day and how I was missing out on life. I could talk about the way my emotions felt numbed and I wasn’t sure I was real anymore. I could explain how I loved, hated, felt I needed and felt I didn’t need the pills; this mess of relationships that had gone unexplored for long enough to tangle me up in it. Add in my parents and my sisters to the mix and the possibilities for dialogue expand exponentially. Each of us had our own relationship with the idea of me taking medication, or not.
There were so many things we could have talked about, together or separately. And, yet, conversations about medication were stuck on the merry-go-round of reaffirming its importance and my willingness to try really hard to remember to take it regularly. Dialogues around medication were, I think, a precursor to me making an informed choice. Back then I was – in part – just going along with what I was told to do. Those workers trying to hard to help me remember my medication weren’t trying to stifle the dialogue I so badly needed – it’s just that the question of me taking it or not hadn’t entered the room and no one questioned it. We were all working from the understanding that that decision had already been made, so why go back over it? We didn’t think to step back and be curious about the role medication played in my life. It never made it to our agenda. We were all so convinced, back then, that it was an important part of my recovery.
I didn’t have a worker to talk with about my relationship with medication, so instead I turned to friends and allies within the Hearing Voices Movement. I talked with my partner, too. These conversations helped me clarify some of the different things that were going on inside and around me to do with my decision to take or not take medication. Information was important too. I needed to find out about safer ways of tapering and the risks of sudden withdrawal. Yet without dialogue it was hard to tailor that information to my own situation and life. Without dialogue it was hard to factor in the impact on others of my decision. After all, I’m connected to my loved ones and what happens to me affects them too. They carry stories and memories of me not taking medication with them, for better or worse.
Thinking back, now, I wonder what it would have been like if I had had a worker or an Open Dialogue team to talk with about all this. If I’m honest, there’s a bit of grief that this wasn’t available. Like many, I had to do this work in other ways. Yet, I am fortunate enough to say that I now have a nurse prescriber involved in my support that is open to the idea of me withdrawing again in the future. She’s someone I can imagine walking with me through the process. Meeting her was a matter of luck, however. I wish luck didn’t come in to it.
Want to think more about this?
If you are interested in the topic of nurturing dialogues around medication – in your personal and/or professional life – we are running a one-day workshop on Thursday 15 October (9-5pm UK time). For more information and to book your place, see: Dialogues with … Medication
