Psychiatric Pills And Professional Identities
by David A. Karp Ph. D.

Editor’s Note: David A. Karp, Ph.D. is a professor of sociology at Boston College and is the author of two books, Is it Me or My Meds? and Speaking of Sadness.

My most recent book on mental illness entitled, Is It Me or My Meds? explores questions about identity. It focuses on the connections between pills and personhood. All drugs, legal or illegal, require people to continually justify their use and evaluate their consequences. Certainly every drug has the potential to affect mood and cognition. However I maintain that psychiatric medications are qualitatively different from other medications. In contrast to other medications, psychotropic drugs have as their purpose the transformation of people’s moods, feelings and perceptions. To the extent that this is so, psychiatric medications raise particularly profound questions about authenticity of self and even about the essential character of human consciousness. Of course, the identity implications of psychotropic medications are greatly compounded by the fact that they are used to treat illnesses that place their sufferers into a clearly stigmatized status.

While direct-to-consumer advertising has likely fostered an easier acceptance of these pills, most of the people I interviewed who suffer from major depression embark on psychiatric drug careers with great reluctance. Typically my respondents turn to medications only when desperation leaves them without alternatives. This is understandable in terms of the identity line that one crosses by seeing a doctor, or seeing a diagnosis of depression and filling the prescription for anti-depressants. One person poignantly expressed her identity dilemma by saying that, “When I swallowed that first pill I swallowed my will.” Beginning a regimen of psychiatric medications is part of a traumatic transformation from person to patient; from being a merely troubled person to someone who has a mental illness. Crossing that boundary is hardly an easy step to take.

The people I interviewed came from all walks of life. Since my interest in “Is it me or my meds?” was to establish general patterns that apply to a range of people, I did not pursue some important social psychological questions. After all if pills, like all social objects, carry no intrinsic meanings, we might well expect that different groups of people assess their significance differently. I would hypothesize that the specific meanings attached to psychotropic drugs are different for men and women and vary among different class, ethnic, racial and religious groups. To the point I would expect that the meanings assigned to depression and drug use are different for persons at different points in the occupational structure. More particularly I would expect that members of traditional professions such as doctors and lawyers face distinctive contingencies when they contemplate taking anti-depressant medications. Although only fourteen of the fifty people I spoke with for my book were professionals, their words offer clues about the unique conundrums faced by those whose occupational success requires a posture of unwavering confidence and competence.

Some years ago, a sociologist wrote an article critical of the male dominant professional ethos. In her piece, interestingly titled, Demasculinizing the Professions Chloe Bird wrote that, “To be professional is to be objective, detached, impersonal, authoritative, competitive, stoic, tribal and tough. To be professional, in short, is to be a man.” (quoted in Shulamit Reinharz, On Becoming a Social Scientist, Jossey-Bass, 1979, p. 7). All professionals, both men and women, feel great pressure to adopt a male demeanor in their relationships with colleagues and with clients. If Bird’s description of a masculine, maybe even hyper-masculine, professional stance is correct, we should not be surprised by the reluctance of lawyers and other professionals to shy away from depression diagnoses and medications that mark them as emotionally frail; as persons not even fully in charge of themselves.

Although I did not interview any lawyers, I presume that they share the perspectives of other professionals. One young woman used the imagery of crossing a threshold in describing her decision to take medications for the first time. Andrea was a graduate student in social work preparing for an administrative career. She recalled the emotions stirred up when she stood in front of the hospital doors, deciding whether to keep a medical appointment that would almost certainly lead to a prescription for an anti-depressant medication. She told me, “Just opening the doors was a big deal . . . . it was just a sort of semi-paralysis where I would just . . . . have to steel myself to get through the couple of feet up the stairs to the doorway . . . . and walk through . . . . then there were, like, these doctors walking around and it was very easy to distinguish who was sick and who wasn’t . . . . who had the role of being the professional, by the way they dressed or acted . . . . and it was very difficult straddling the line . . . .Which person am I? Am I the sick person or am I the professional?”

One of the most surprising things I learned from a few conversations is just how unforgiving the members of one’s profession are towards colleagues with illnesses, especially mental illnesses. I first sensed this when a family friend, a physician who had just read my earlier book on depression, Speaking of Sadness, called me at home. He was eager to talk about the book and his struggles with depression. After acknowledging that our conversation was one of the few times in his life when he had openly talked about his illness, I expressed surprise, asking why he did not share his plight with medical colleagues, especially psychiatrists. He told me it just wasn’t done and that “you’d stop getting referrals.” How unfortunate that a profession presumably dedicated to care cannot extend compassion to one of its own. I bet that many reading this essay would find it sensible to replace the words “physician” and “surgeon” with “lawyer” in the following account of a doctor who said:

“I go to a physician support group, and they were talking about how there was a group of surgeons, and one of the surgeons came down with cancer and had to start slacking off on the amount of work that this person did. And all the partners were grumbling and being upset about the fact that they had to take up the slack. And they may have expressed concern, but it didn’t come out in their behavior, you know. A mental illness . . . . I mean, a physician with mental illness is considered impaired. I mean, it’s tantamount to being an addict.”

Pill taking is a social act. We may take pills in private, when we are all alone, but we are always mindful of those who make judgments about our problems. My conversations about medications contain countless references to significant others - - what a parent feels about one’s illness, how taking medication affects a spouse, when to tell a new lover about medication use, which friends to confide in, how caregivers respond to one’s feelings and concerns, whether to open up to co-workers. When work came up in my interviews I heard lots of stories about discrimination toward people with psychiatric illnesses that led to a simple and shared conclusion: “Don’t tell!” One young woman explained, “Every time you pull out those medications, it’s a reminder of [your illness]. And, I mean, I was working in a little cubicle, but it’s like I have to hide. I mean, people take [other] medications there, but I feel like I had to hide it.” Unhappily, the need to sustain secretly in the workplace only contributes to the burden of depression, an illness that already fosters isolation. While the problem is pervasive, I suspect that the taboo about telling is most pronounced among professionals who have been socialized to avoid any sign of weakness.

The limitation of much sociological analysis is that it identifies the structural sources of human problems without providing clear solutions. Here I have speculated about the negative consequences of a professional value system demanding that its practitioners be objective, detached, and personal, authoritative, competitive, stoic, tribal and tough. At the same time, there is room for optimism. Forums (like this website) that invite open conversation about a difficult subject can be personally liberating and contribute to the eventual transformation of hurtful social systems. We can never change oppression until we first recognize it as oppression and then understand its origins. Wouldn’t it be nice if one day taking anti-depressants at work had no greater significance than publicly using aspirin for a headache?