The clients referred to me for psychopharmacology consultation often seem to feel a certain relief once they’ve let me know that, when it comes to meds, they’ve tried “everything” and so far “nothing” has worked. After we’ve run down the list of what they’ve taken and how it’s failed to make any difference in their mood or state of agitation or ability to concentrate, they sit back as if to say, “Now it’s your turn.” In fact, this is the kind of ritual that they’re used to: once they’ve told the unhappy tale of their symptoms and the frustrating failure of drugs to do much good, what else is there for them to say?
My answer? Plenty. Here’s where I break from their expected ritual and explain that I work a bit differently than most prescribers. I believe that the chemical effect of pills is only part of their impact. The other part may seem a little weird, I warn clients, but it has to do with their thoughts, feelings, and expectations around the medications they take—in other words, their relationship with their drugs. I emphasize that for some people, more may be riding on this relationship, the source of so much hope and potential disappointment, than on any other in their life. Understandably, this notion gives many people pause; they’re not used to considering the chemical agents in their daily lives to be like a living, breathing psychological presence in their minds, whether conscious or not.
But then I say something that’s often even more startling to…