This is an essay I wrote as my final paper for West Chester University's GSW class on Oppression and Liberation. Dr. Page Buck was my professor.
It’s Kind of a Funny Story
SSRI Use and Its Oppression
Kimberly J. Beam
West Chester University
December 1, 2012
Introduction
Ned Vizzini explores the world of selective serotonin reuptake inhibitors (SSRIs) in his novel, It’s Kind of a Funny Story (2006). Whether Vizzini means to or not, he dramatizes what happens to many people when they are diagnosed and first prescribed an SSRI.
The last page, after the novel ends, states, “Ned Vizzini spent five days in adult psychiatric in Methodist Hospital, Park Slope, Brooklyn, 11/29/04-12/3/04. Ned wrote this 12/10/04-1/6/05” (Vizzini, 2006, p. 445). Vizzini came out of his experience on an adult psychiatric medical floor and wrote about it using a fifteen year old as his protagonist. In so doing, he expresses the fear of the stereotypes of taking an SSRI, the fear of what people think, and how one views their own person for needing psychopharmacological aids.
Background
The protagonist, Craig Gilner, is a fifteen year old, depressed, suicidal teenager who attends “Executive Pre-Professional High School” in New York City. Vizzini used the pseudonym “Executive Pre-Professional High School” for what is really his alma mater, Stuyvesant High School (http://www.gotham-artists.com/ned_vizzini.html), which is ranked nine for New York City’s public schools and ranked number 58 for the nation (http://www.usnews.com/education/best-high-schools/new-york/districts/new-york-city-public-schools/stuyvesant-high-school-13092). In order to attend Stuyvesant, one must pass the entrance exam. Once in, Gilner’s experiences reveal just how rigorous the coursework is and how the pressures begin to affect him physically.
Craig Gilner is Ned Vizzini’s protagonist in It’s Kind of a Funny Story. However, much of what Vizzini writes as fiction, he actually experienced himself. Vizzini was feeling pressure to produce a third book, but hadn’t a clue what to write. “Cycling thoughts and difficulties eating became the norm, and by the time Vizzini called the Hotline, he hardly recognized himself” (http://www.gotham-artists.com/ned_vizzini.html). Ned Vizzini used his own experiences to help create his character, Craig Gilner; for both the author and his character, their help on the other end of the phone line wasn’t from the suicide hotline, but from a rollover answering service because the suicide hotline was full (http://www.gotham-artists.com/ned_vizzini.html). Though this is a work of fiction, it is grounded in Vizzini’s own experiences, his own thoughts and feelings as he went through the stereotypes, stigmas and internalized oppression of being prescribed an SSRI for depression and then coming off his SSRI without consulting his doctor.
Oppression, stigma and stereotype defined
Oppression is defined by dictionary.com as “the exercise of authority or power in a burdensome, cruel, or unjust manner.” Though not every member of our society judges a person for their SSRI use, there are some who would judge another unjustly for their need for one. Jokes are rampant in television shows and movies where the term, “Prozac” is synonymous with one who cannot handle the stressful situations they are placed in and must lean on drugs to cope. In fact, the way most people react to taking an SSRI comes from the way they are judged or the way they judge themselves for needing the medication.
The term stigma is also used in relation to medication use. Dictionary.com defines stigma as “a mark of disgrace or infamy; a stain or reproach, as on one's reputation.” Stigma, like oppression, has judgment at its core. It has power at its foundation; those who consider themselves above the stigmatized individual oppress those who are stigmatized. When the word “stigma” and its forms are used in this paper, oppression is at its heart.
The word stereotype also has judgment at its core. The term implies the ideal image of, what one pictures as the epitome of a group. Some common stereotypes state that CEO’s are money-hungry businessmen, who completely forget they have a family who needs them; the media is made up of nosy, insensitive interlopers; the football player is a dumb jock; and the cheerleader a slutty, ditzy, blonde (where the word “blonde” is a stereotype in itself). Stereotypes are also a form of oppression; those who are stereotyped are judged as being like the popularly held image of the group to whom they are prescribed to belong. Those who are stereotyped are not evaluated for who they really are.
The “problem” of stereotypes
Though the stigma of medication use in teenagers and adults is decreasing, it is still an issue (Sharp, 2012). As a society, Americans are born out of the Puritan and colonist spirits: work hard, rely on yourself alone and be strong. Weakness of any kind is not typically valued or respected. “In our society, there is a common understanding that people are responsible beings who should be able to handle their problems by themselves and should not depend on medication for the mind to solve their problems” (Verbeek-Heida and Mathot, 2006, p.135). To say that one is on a selective serotonin re-uptake inhibitor (SSRI) for depression, anxiety, or post-traumatic stress disorder is to admit that one is weak, that one cannot cope with daily life and its trials.
Gilner was prescribed Zoloft, but he doesn’t talk about it often (Vizzini, 2006). He mentioned it once to his best-friend’s girlfriend, Nia, who responded, “‘Craig, like 80 percent of the people I know are on medication. For ADD or whatever” (Vizzini, 2006, p. 119). Though Nia is aware that she is not alone in her prescription of Prozac, she still doesn’t disclose to her boyfriend, Aaron, about what medication she is taking, explaining, “‘He doesn’t need to know’” (Vizzini, 2006, p. 120). Nia is sleeping with Aaron. She is sharing deeply personal moments with him, but she doesn’t trust her boyfriend with the information that she is taking an SSRI.
Stereotypes have a life beyond facts. Their origin lies in a culture’s ideology — the general system of beliefs by which it lives — and they are sustained across generations by diverse cultural transmissions, hardly any of which, including slang and jokes, even purport to have a scientific basis (Mohr, 2010, p.579).
Americans judge people based on skin-color, clothing, hairstyles and even the shoes one wears. Stereotypes also exist for some who take SSRIs, a medication that can have the power to prove to the one diagnosed and the rest of society that they are weak, incapable of maintaining their intense lifestyles and are dependent on a substance in order to function in daily interactions. In fact, when Craig Gilner’s best friend, Aaron, does discover that both Nia and Craig take SSRI’s Craig and Nia’s fear of judgment and oppression are founded. Aaron “jokes” with Craig with words that aren’t funny, saying he is in the “‘loony bin,’” that Craig’s “‘the craziest person’” Aaron knows; he also dumps Nia for needing “pills” which is what both Aaron and Craig call SSRI’s (Vizzini, 2006, p. 254-255). But worse, after he hangs up the phone on Aaron, Gilner’s biggest is fear is that everyone in school now knows where he is, why he’s there and that he’s taking an SSRI. He fears the oppression he will experience at school now that everyone knows his story, now that everyone knows he cannot handle the pressures of Executive Pre-Professional.
In order to cover what someone might think when one admits to taking an SSRI, the person will often give reasons to try to explain their prescriptions. “Our informants gave biochemical and physical reasons to justify why they could not help but handle their mental problems with medications. …they thought that taking pills for the mind was problematic for their self-image” (Verbeek-Heida and Mathot, 2006, p. 141). Just saying that one is taking an SSRI isn’t enough in our culture. One has to preface with why and when and how low a dose one is taking. There are caveats and explanations given out of fear of what an outsider will think and the oppression that follows from judgment. Along with the judgment from stereotypes and perceived weakness, the person taking the medication has to accept the fact that they are taking the SSRI, which means that they must admit to themselves that they do not fit into society’s norms and expectations. This is a form of internalized oppression, where the individual in need of the SSRI blames themselves for their weaknesses and judges themselves for the distress they experience for both needing and taking an SSRI.
Gilner is no exception. According to Deacon and Baird (2009), “…the popular ‘chemical imbalance’ explanation of depression, [has] been widely disseminated in an attempt to reduce the stigma of mental illness” (p. 415). Gilner completely understands the biological processes in place that are causing his depression. He knows that it’s caused by the neurotransmitter, serotonin. “‘If you have a lack of this chemical in your system, you can start to get depressed’” (Vizzini, 2006, p. 108-109). Gilner has this thorough understanding of the way his brain is working through reading ahead in his biology textbook. He knows his brain is trying to take in as much serotonin as possible, leaving none to “‘carry the messages,’” causing his depression (Vizzini, 2006, p. 109). This reveals that he has internalized the way his body isn’t processing neurotransmitters properly and that has become the cause of his depression. It has nothing to do with his strength, his internal force, his ability to perform or not perform on tests or to complete or not complete his homework. “Participants perceived themselves as less responsible and morally culpable for being depressed when their symptoms were attributed to faulty brain chemistry” (Deacon and Baird, 2009, p. 430). It is a situation outside of his force of will that is making him depressed. In the end, this biological issue is what makes it “okay” to take the medication. If it’s a biological issue, there isn’t room for oppression and stigmas to have the power and authority of judgment over an SSRI user.
The pseudo-shift
Gilner struggles through much of the novel, that even though he is on medication, it hasn’t solved his problem — it is just a band-aid of sorts, but his brain still isn’t back to normal. This is what he calls the “Fake Shift.”
But there are moments when it comes together. The Shift hasn’t happened yet, maybe it never will, but sometimes — just enough times to give me hope — my brain jars back into where it’s supposed to be. When I feel one of these (I call them Fake Shifts) I should always eat, although I don’t… (Vizzini, 2006, p. 33).
Gilner is not alone in his self-assessment that because he needs medication then he’s not really “okay.” Many people who are studied in SSRI research feel the same as he. “The dilemma is this: people felt normal with the medicines, but at the same time considered that they would only be normal (in the end) without the medicines” (Verbeek-Heida and Mathot, 2006, p. 137). It is a paradox, a conundrum, and one that is not easily solved. The patient feels better on the medication, but medication is for one who is sick; if one feels better, but still needs medication to keep them at their current functioning level, are they really better?
Because Gilner is like so many who feel “a period of uncertainty about the effects of SSRIs,” (Verbeek-Heida and Mathot, 2006, p.136) he, like so many on SSRIs, stops his dosage. “…many patients stop anti-depressants intentionally when they start to feel better” (Mitchell, 2007, p. 34). The number of people who stop are so consistent and normal that statistics have been able to be kept: one third stops “within 3 months, citing feeling better as the reason and 55% stop when feeling better within 6 months” (Mitchell, 2007, p. 34).
Gilner says, “So when I ran out of the final bottle of Zoloft, I didn’t take any more…. Pills were for wimps, and this was over; I was done; I was back to me” (Vizzini, 2006, p.122). And just like “50% of patients who were depressed believed they did not need their anti-depressants when they began to feel better,” (Mitchell, 2007, p. 34), Gilner cut off the very thing that was allowing him to eat and sleep normally. He was getting his schoolwork completed and his brain wasn’t “cycling” anymore, but he didn’t see that staying on the medication would help him continue this. He stopped taking the medication because he was feeling better, believing he didn’t need it anymore, believing that if he continued to take an SSRI he was a “wimp.”
His judgment of himself for needing an SSRI and calling himself a “wimp” for taking one shows that he has turned society’s oppression for his SSRI use onto himself. This is called internalized oppression, where one judges, blames and feels less than everyone else in society because of what they perceive as a weakness inside themselves. These self-judgments are just as powerful as outside judgments, for they oppress the individuals into silence and shame. These self-judgments also cause a person to stop taking their SSRIs, which are helping them feel normal.
Accepting one's need for SSRI use
Gilner’s self-assurance and internalized oppression that “pills are for wimps,” fails when, two months later, he is back in the bathroom throwing up and the plan to jump off the Brooklyn Bridge is at the forefront of his mind. He winds up in a hospital emergency room, filling out forms and answering questions to a nurse who calls him, “ishkabibbles” and says she sees a lot of patients who say that they stopped taking their medication (Vizzini, 2006, pp. 157-158). She says:
“You really have to stop, right now, and think about how you feel. I want you to remember how you feel the next time you decide to stop taking your medicine.”
“Okay.” I commit it to memory; I feel dead, wasted, awful, broken, and useless. It’s not the kind of feeling you forget (Vizzini, 2006, p. 158).
This is where the nurse is watering the seeds that are already implanted in the SSRI user’s mind: Will it be possible to ever come off the medication?
Participants of different research groups have all expressed this concern in the studies that looked at SSRI users’ feelings toward their medication. “In general, the informants had ambivalent feelings toward the medicine. They wanted to quit and not be dependent on their medicine; on the other hand, they were afraid of slipping back into the ‘stage of distress’” (Knudsen, Hansen, Traulsen & Eskildsen, 2002, p. 939). Just like the nurse looked at Gilner and said, “…remember how you feel the next time you decide to stop taking your medicine” (Vizzini, 2006, p. 158), SSRI users remember how they felt, the distress that led them to start up the medication in the first place. Of course they remember the symptoms that led them to seek medical professional help, but that doesn’t stop them from feeling ambivalent, wishing they could get off the medication for a number of different reasons (what people think of them, what they think of themselves, what the medicine is doing to them on a long-term basis, how they want to be strong and independent — like society expects) and fear of how their bodies will react if they do (Knudsen, Hansen, Traulsen & Eskildsen, 2002).
Just because the novel ends with Gilner being released from the psychiatric floor, feeling okay with being on his medication and experiencing an official “shift [in his brain] a little bit to the left” (Vizzini, 2006, p.443), does not mean the story also ends for Craig Gilner’s creator, Ned Vizzini. Vizzini is going to remember the emotions that led him to admit himself into the hospital. He is going to remember the darkness and how much he was not like himself. There are a couple of options for how Vizzini is going to react to being on medication. He could fight the medication and try to come off of it again, or at least ponder if he should; he might experience fear on both sides about coming off or staying on. Another alternative is he’s going to have to accept that this is how his body is and remain on the medication.
Research shows if a person comes to accept that they are going to be taking an SSRI for a long time, with no thoughts of stopping, this “has a tendency to give experienced users the idea that their condition is a chronic one: the condition probably cannot be cured, but can be managed by medication, just like other chronic illnesses” (Verbeek-Heida & Mathot, 2006, p. 141). More and more “major depression is increasingly thought of as a chronic illness” (Mitchell, 2007, p. 34). By classifying depression as a chronic illness, such as diabetes, asthma, or arthritis, it allows the stigma the people of the United States have against depression, anxiety and other brain chemical conditions to fall away. As a chronic illness, it is no longer thought of as a psychological disorder, but it becomes a biological illness that can be stabilized through the use of medication, without some of the stigmas, judgments and oppression.
The role of the social worker
A social worker is called to be an agency of change – a person who adheres to the National Association of Social Worker’s Code of Ethics works to prevent and eliminate any forms of discrimination against an individual (NASW, 2008). In the case of the SSRI user, the social worker is not only working to help the client orient to their new diagnosis and prescription, but also working to minimize the client’s fears of discrimination for their need for medication. The client faces two different types of possible oppression for needing an SSRI – from people outside of the client’s person and from the client’s own personal judgments and discriminations of him/herself.
One of the main roles of the social worker when working with an individual who is on an SSRI is education, especially if they are newly prescribed or contemplating being prescribed one. With education, the distress surrounding SSRI use can be lessened. With the help of a social worker, the individual can work through the stigmas, the stereotypes, the fear of oppression and help their client accept their situation as a medical condition rather than as a psychological one. The social worker would hopefully be an individual who is accepting, understanding and supportive.
Education would allow the individual to asses his / her beliefs about using the SSRI and what long-term use means for them. By working with a social worker, the SSRI user might have a higher chance of adjustment, success and understanding of their internalized oppression (how they judge themselves for needing an SSRI). They might also have a higher chance of understanding their fear of oppression from those around them.
A social worker would, hopefully, be able to guide a new SSRI user into understanding the possible side effects of the SSRI. One of the side effects of Prozac is energy – it’s an upper. Drinking caffeine while on Prozac is not wise, as caffeine could cause panic attacks. Another issue is Prozac could keep one from falling asleep. If the doctor recommended the patient take Prozac before bed, it could keep the patient awake. Since it is a timed-release medication, the patient should not switch and just take the medication 12 hours later in the morning instead. The patient should take it an hour or two earlier every day until they are taking it in the morning instead of at night. A good social worker would be able to help their clients manage the multi-facets of SSRI use.
SSRI’s are prescribed to help the brain function better, but there are not any tests to know which chemicals a particular person is lacking. As a result, doctors prescribe in a sort of guessing game until they find the right drug to meet the patient’s needs. A good social worker should be able to help a client understand if the prescribed SSRI is helping or hindering the patient from achieving balance. The social worker will be able to help the patient sort through their feelings about the SSRI, and to evaluate the benefits or drawbacks of the particular medication they have been prescribed.
Conclusion
Craig Gilner’s story (and Ned Vizzini’s by default) is similar to many people’s who have experienced anxiety, depression or other conditions that are treated through an SSRI. They move through the distressed stage, where the person recognizes they need help, to the “resistance” stage where the SSRI user is conflicted about the fact they need the medication - feeling that they should be able to handle their problems on their own. The third stage is one of “improvement, where they regained their sense of self and were able to function in everyday life again;” ending in the fourth stage, where the SSRI user questions the continued use of the medication and experiences uncertainty on both sides of the issue about stopping the dosage. The SSRI user will have to face the fear of feeling distressed again or deal with what being on an SSRI long-term means (Knudsen, Hansen, Traulsen and Eskildsen, 2002).
The reason Vizzini and so many people from the United States go through such stages around needing an SSRI is rooted in our culture and the way people stereotype mental health issues and psychology. Our country was founded on the colonist spirits of working hard, muscling through and not letting sickness or weakness stop one’s success. Our culture was founded on each person making their own way, being able to sustain one’s self and one’s family — giving to those in need was accepted, being on the receiving end of charity was shunned. These high expectations of the American spirit still hold today. People still believe taking a handout is wrong and those that give the handouts are beneficent and noble.
Admitting one cannot live up to the ideals of one’s culture can put one in distress. It’s hard to realize that one does not measure up to society’s unreachable standards. This is what causes the four stages of adjustment in SSRI use. Our society’s judgment and stereotyping of people puts expectations on the members of our society. Our culture expects others to live up to an unattainable standard and that is what makes an individual view their need for an SSRI as not only a comment on themselves, but also as comments on their weaknesses, ailments or inabilities. Instead, the judgments, stereotypes of society, the internalized oppression, the unreachable expectations, and the drive to be perfect are never examined for what they really are: comments on the unbending and uncompassionate nature of our society.
Ned Vizzini explores the world of selective serotonin reuptake inhibitors (SSRIs) in his novel, It’s Kind of a Funny Story (2006). Whether Vizzini means to or not, he dramatizes what happens to many people when they are diagnosed and first prescribed an SSRI.
The last page, after the novel ends, states, “Ned Vizzini spent five days in adult psychiatric in Methodist Hospital, Park Slope, Brooklyn, 11/29/04-12/3/04. Ned wrote this 12/10/04-1/6/05” (Vizzini, 2006, p. 445). Vizzini came out of his experience on an adult psychiatric medical floor and wrote about it using a fifteen year old as his protagonist. In so doing, he expresses the fear of the stereotypes of taking an SSRI, the fear of what people think, and how one views their own person for needing psychopharmacological aids.
Background
The protagonist, Craig Gilner, is a fifteen year old, depressed, suicidal teenager who attends “Executive Pre-Professional High School” in New York City. Vizzini used the pseudonym “Executive Pre-Professional High School” for what is really his alma mater, Stuyvesant High School (http://www.gotham-artists.com/ned_vizzini.html), which is ranked nine for New York City’s public schools and ranked number 58 for the nation (http://www.usnews.com/education/best-high-schools/new-york/districts/new-york-city-public-schools/stuyvesant-high-school-13092). In order to attend Stuyvesant, one must pass the entrance exam. Once in, Gilner’s experiences reveal just how rigorous the coursework is and how the pressures begin to affect him physically.
Craig Gilner is Ned Vizzini’s protagonist in It’s Kind of a Funny Story. However, much of what Vizzini writes as fiction, he actually experienced himself. Vizzini was feeling pressure to produce a third book, but hadn’t a clue what to write. “Cycling thoughts and difficulties eating became the norm, and by the time Vizzini called the Hotline, he hardly recognized himself” (http://www.gotham-artists.com/ned_vizzini.html). Ned Vizzini used his own experiences to help create his character, Craig Gilner; for both the author and his character, their help on the other end of the phone line wasn’t from the suicide hotline, but from a rollover answering service because the suicide hotline was full (http://www.gotham-artists.com/ned_vizzini.html). Though this is a work of fiction, it is grounded in Vizzini’s own experiences, his own thoughts and feelings as he went through the stereotypes, stigmas and internalized oppression of being prescribed an SSRI for depression and then coming off his SSRI without consulting his doctor.
Oppression, stigma and stereotype defined
Oppression is defined by dictionary.com as “the exercise of authority or power in a burdensome, cruel, or unjust manner.” Though not every member of our society judges a person for their SSRI use, there are some who would judge another unjustly for their need for one. Jokes are rampant in television shows and movies where the term, “Prozac” is synonymous with one who cannot handle the stressful situations they are placed in and must lean on drugs to cope. In fact, the way most people react to taking an SSRI comes from the way they are judged or the way they judge themselves for needing the medication.
The term stigma is also used in relation to medication use. Dictionary.com defines stigma as “a mark of disgrace or infamy; a stain or reproach, as on one's reputation.” Stigma, like oppression, has judgment at its core. It has power at its foundation; those who consider themselves above the stigmatized individual oppress those who are stigmatized. When the word “stigma” and its forms are used in this paper, oppression is at its heart.
The word stereotype also has judgment at its core. The term implies the ideal image of, what one pictures as the epitome of a group. Some common stereotypes state that CEO’s are money-hungry businessmen, who completely forget they have a family who needs them; the media is made up of nosy, insensitive interlopers; the football player is a dumb jock; and the cheerleader a slutty, ditzy, blonde (where the word “blonde” is a stereotype in itself). Stereotypes are also a form of oppression; those who are stereotyped are judged as being like the popularly held image of the group to whom they are prescribed to belong. Those who are stereotyped are not evaluated for who they really are.
The “problem” of stereotypes
Though the stigma of medication use in teenagers and adults is decreasing, it is still an issue (Sharp, 2012). As a society, Americans are born out of the Puritan and colonist spirits: work hard, rely on yourself alone and be strong. Weakness of any kind is not typically valued or respected. “In our society, there is a common understanding that people are responsible beings who should be able to handle their problems by themselves and should not depend on medication for the mind to solve their problems” (Verbeek-Heida and Mathot, 2006, p.135). To say that one is on a selective serotonin re-uptake inhibitor (SSRI) for depression, anxiety, or post-traumatic stress disorder is to admit that one is weak, that one cannot cope with daily life and its trials.
Gilner was prescribed Zoloft, but he doesn’t talk about it often (Vizzini, 2006). He mentioned it once to his best-friend’s girlfriend, Nia, who responded, “‘Craig, like 80 percent of the people I know are on medication. For ADD or whatever” (Vizzini, 2006, p. 119). Though Nia is aware that she is not alone in her prescription of Prozac, she still doesn’t disclose to her boyfriend, Aaron, about what medication she is taking, explaining, “‘He doesn’t need to know’” (Vizzini, 2006, p. 120). Nia is sleeping with Aaron. She is sharing deeply personal moments with him, but she doesn’t trust her boyfriend with the information that she is taking an SSRI.
Stereotypes have a life beyond facts. Their origin lies in a culture’s ideology — the general system of beliefs by which it lives — and they are sustained across generations by diverse cultural transmissions, hardly any of which, including slang and jokes, even purport to have a scientific basis (Mohr, 2010, p.579).
Americans judge people based on skin-color, clothing, hairstyles and even the shoes one wears. Stereotypes also exist for some who take SSRIs, a medication that can have the power to prove to the one diagnosed and the rest of society that they are weak, incapable of maintaining their intense lifestyles and are dependent on a substance in order to function in daily interactions. In fact, when Craig Gilner’s best friend, Aaron, does discover that both Nia and Craig take SSRI’s Craig and Nia’s fear of judgment and oppression are founded. Aaron “jokes” with Craig with words that aren’t funny, saying he is in the “‘loony bin,’” that Craig’s “‘the craziest person’” Aaron knows; he also dumps Nia for needing “pills” which is what both Aaron and Craig call SSRI’s (Vizzini, 2006, p. 254-255). But worse, after he hangs up the phone on Aaron, Gilner’s biggest is fear is that everyone in school now knows where he is, why he’s there and that he’s taking an SSRI. He fears the oppression he will experience at school now that everyone knows his story, now that everyone knows he cannot handle the pressures of Executive Pre-Professional.
In order to cover what someone might think when one admits to taking an SSRI, the person will often give reasons to try to explain their prescriptions. “Our informants gave biochemical and physical reasons to justify why they could not help but handle their mental problems with medications. …they thought that taking pills for the mind was problematic for their self-image” (Verbeek-Heida and Mathot, 2006, p. 141). Just saying that one is taking an SSRI isn’t enough in our culture. One has to preface with why and when and how low a dose one is taking. There are caveats and explanations given out of fear of what an outsider will think and the oppression that follows from judgment. Along with the judgment from stereotypes and perceived weakness, the person taking the medication has to accept the fact that they are taking the SSRI, which means that they must admit to themselves that they do not fit into society’s norms and expectations. This is a form of internalized oppression, where the individual in need of the SSRI blames themselves for their weaknesses and judges themselves for the distress they experience for both needing and taking an SSRI.
Gilner is no exception. According to Deacon and Baird (2009), “…the popular ‘chemical imbalance’ explanation of depression, [has] been widely disseminated in an attempt to reduce the stigma of mental illness” (p. 415). Gilner completely understands the biological processes in place that are causing his depression. He knows that it’s caused by the neurotransmitter, serotonin. “‘If you have a lack of this chemical in your system, you can start to get depressed’” (Vizzini, 2006, p. 108-109). Gilner has this thorough understanding of the way his brain is working through reading ahead in his biology textbook. He knows his brain is trying to take in as much serotonin as possible, leaving none to “‘carry the messages,’” causing his depression (Vizzini, 2006, p. 109). This reveals that he has internalized the way his body isn’t processing neurotransmitters properly and that has become the cause of his depression. It has nothing to do with his strength, his internal force, his ability to perform or not perform on tests or to complete or not complete his homework. “Participants perceived themselves as less responsible and morally culpable for being depressed when their symptoms were attributed to faulty brain chemistry” (Deacon and Baird, 2009, p. 430). It is a situation outside of his force of will that is making him depressed. In the end, this biological issue is what makes it “okay” to take the medication. If it’s a biological issue, there isn’t room for oppression and stigmas to have the power and authority of judgment over an SSRI user.
The pseudo-shift
Gilner struggles through much of the novel, that even though he is on medication, it hasn’t solved his problem — it is just a band-aid of sorts, but his brain still isn’t back to normal. This is what he calls the “Fake Shift.”
But there are moments when it comes together. The Shift hasn’t happened yet, maybe it never will, but sometimes — just enough times to give me hope — my brain jars back into where it’s supposed to be. When I feel one of these (I call them Fake Shifts) I should always eat, although I don’t… (Vizzini, 2006, p. 33).
Gilner is not alone in his self-assessment that because he needs medication then he’s not really “okay.” Many people who are studied in SSRI research feel the same as he. “The dilemma is this: people felt normal with the medicines, but at the same time considered that they would only be normal (in the end) without the medicines” (Verbeek-Heida and Mathot, 2006, p. 137). It is a paradox, a conundrum, and one that is not easily solved. The patient feels better on the medication, but medication is for one who is sick; if one feels better, but still needs medication to keep them at their current functioning level, are they really better?
Because Gilner is like so many who feel “a period of uncertainty about the effects of SSRIs,” (Verbeek-Heida and Mathot, 2006, p.136) he, like so many on SSRIs, stops his dosage. “…many patients stop anti-depressants intentionally when they start to feel better” (Mitchell, 2007, p. 34). The number of people who stop are so consistent and normal that statistics have been able to be kept: one third stops “within 3 months, citing feeling better as the reason and 55% stop when feeling better within 6 months” (Mitchell, 2007, p. 34).
Gilner says, “So when I ran out of the final bottle of Zoloft, I didn’t take any more…. Pills were for wimps, and this was over; I was done; I was back to me” (Vizzini, 2006, p.122). And just like “50% of patients who were depressed believed they did not need their anti-depressants when they began to feel better,” (Mitchell, 2007, p. 34), Gilner cut off the very thing that was allowing him to eat and sleep normally. He was getting his schoolwork completed and his brain wasn’t “cycling” anymore, but he didn’t see that staying on the medication would help him continue this. He stopped taking the medication because he was feeling better, believing he didn’t need it anymore, believing that if he continued to take an SSRI he was a “wimp.”
His judgment of himself for needing an SSRI and calling himself a “wimp” for taking one shows that he has turned society’s oppression for his SSRI use onto himself. This is called internalized oppression, where one judges, blames and feels less than everyone else in society because of what they perceive as a weakness inside themselves. These self-judgments are just as powerful as outside judgments, for they oppress the individuals into silence and shame. These self-judgments also cause a person to stop taking their SSRIs, which are helping them feel normal.
Accepting one's need for SSRI use
Gilner’s self-assurance and internalized oppression that “pills are for wimps,” fails when, two months later, he is back in the bathroom throwing up and the plan to jump off the Brooklyn Bridge is at the forefront of his mind. He winds up in a hospital emergency room, filling out forms and answering questions to a nurse who calls him, “ishkabibbles” and says she sees a lot of patients who say that they stopped taking their medication (Vizzini, 2006, pp. 157-158). She says:
“You really have to stop, right now, and think about how you feel. I want you to remember how you feel the next time you decide to stop taking your medicine.”
“Okay.” I commit it to memory; I feel dead, wasted, awful, broken, and useless. It’s not the kind of feeling you forget (Vizzini, 2006, p. 158).
This is where the nurse is watering the seeds that are already implanted in the SSRI user’s mind: Will it be possible to ever come off the medication?
Participants of different research groups have all expressed this concern in the studies that looked at SSRI users’ feelings toward their medication. “In general, the informants had ambivalent feelings toward the medicine. They wanted to quit and not be dependent on their medicine; on the other hand, they were afraid of slipping back into the ‘stage of distress’” (Knudsen, Hansen, Traulsen & Eskildsen, 2002, p. 939). Just like the nurse looked at Gilner and said, “…remember how you feel the next time you decide to stop taking your medicine” (Vizzini, 2006, p. 158), SSRI users remember how they felt, the distress that led them to start up the medication in the first place. Of course they remember the symptoms that led them to seek medical professional help, but that doesn’t stop them from feeling ambivalent, wishing they could get off the medication for a number of different reasons (what people think of them, what they think of themselves, what the medicine is doing to them on a long-term basis, how they want to be strong and independent — like society expects) and fear of how their bodies will react if they do (Knudsen, Hansen, Traulsen & Eskildsen, 2002).
Just because the novel ends with Gilner being released from the psychiatric floor, feeling okay with being on his medication and experiencing an official “shift [in his brain] a little bit to the left” (Vizzini, 2006, p.443), does not mean the story also ends for Craig Gilner’s creator, Ned Vizzini. Vizzini is going to remember the emotions that led him to admit himself into the hospital. He is going to remember the darkness and how much he was not like himself. There are a couple of options for how Vizzini is going to react to being on medication. He could fight the medication and try to come off of it again, or at least ponder if he should; he might experience fear on both sides about coming off or staying on. Another alternative is he’s going to have to accept that this is how his body is and remain on the medication.
Research shows if a person comes to accept that they are going to be taking an SSRI for a long time, with no thoughts of stopping, this “has a tendency to give experienced users the idea that their condition is a chronic one: the condition probably cannot be cured, but can be managed by medication, just like other chronic illnesses” (Verbeek-Heida & Mathot, 2006, p. 141). More and more “major depression is increasingly thought of as a chronic illness” (Mitchell, 2007, p. 34). By classifying depression as a chronic illness, such as diabetes, asthma, or arthritis, it allows the stigma the people of the United States have against depression, anxiety and other brain chemical conditions to fall away. As a chronic illness, it is no longer thought of as a psychological disorder, but it becomes a biological illness that can be stabilized through the use of medication, without some of the stigmas, judgments and oppression.
The role of the social worker
A social worker is called to be an agency of change – a person who adheres to the National Association of Social Worker’s Code of Ethics works to prevent and eliminate any forms of discrimination against an individual (NASW, 2008). In the case of the SSRI user, the social worker is not only working to help the client orient to their new diagnosis and prescription, but also working to minimize the client’s fears of discrimination for their need for medication. The client faces two different types of possible oppression for needing an SSRI – from people outside of the client’s person and from the client’s own personal judgments and discriminations of him/herself.
One of the main roles of the social worker when working with an individual who is on an SSRI is education, especially if they are newly prescribed or contemplating being prescribed one. With education, the distress surrounding SSRI use can be lessened. With the help of a social worker, the individual can work through the stigmas, the stereotypes, the fear of oppression and help their client accept their situation as a medical condition rather than as a psychological one. The social worker would hopefully be an individual who is accepting, understanding and supportive.
Education would allow the individual to asses his / her beliefs about using the SSRI and what long-term use means for them. By working with a social worker, the SSRI user might have a higher chance of adjustment, success and understanding of their internalized oppression (how they judge themselves for needing an SSRI). They might also have a higher chance of understanding their fear of oppression from those around them.
A social worker would, hopefully, be able to guide a new SSRI user into understanding the possible side effects of the SSRI. One of the side effects of Prozac is energy – it’s an upper. Drinking caffeine while on Prozac is not wise, as caffeine could cause panic attacks. Another issue is Prozac could keep one from falling asleep. If the doctor recommended the patient take Prozac before bed, it could keep the patient awake. Since it is a timed-release medication, the patient should not switch and just take the medication 12 hours later in the morning instead. The patient should take it an hour or two earlier every day until they are taking it in the morning instead of at night. A good social worker would be able to help their clients manage the multi-facets of SSRI use.
SSRI’s are prescribed to help the brain function better, but there are not any tests to know which chemicals a particular person is lacking. As a result, doctors prescribe in a sort of guessing game until they find the right drug to meet the patient’s needs. A good social worker should be able to help a client understand if the prescribed SSRI is helping or hindering the patient from achieving balance. The social worker will be able to help the patient sort through their feelings about the SSRI, and to evaluate the benefits or drawbacks of the particular medication they have been prescribed.
Conclusion
Craig Gilner’s story (and Ned Vizzini’s by default) is similar to many people’s who have experienced anxiety, depression or other conditions that are treated through an SSRI. They move through the distressed stage, where the person recognizes they need help, to the “resistance” stage where the SSRI user is conflicted about the fact they need the medication - feeling that they should be able to handle their problems on their own. The third stage is one of “improvement, where they regained their sense of self and were able to function in everyday life again;” ending in the fourth stage, where the SSRI user questions the continued use of the medication and experiences uncertainty on both sides of the issue about stopping the dosage. The SSRI user will have to face the fear of feeling distressed again or deal with what being on an SSRI long-term means (Knudsen, Hansen, Traulsen and Eskildsen, 2002).
The reason Vizzini and so many people from the United States go through such stages around needing an SSRI is rooted in our culture and the way people stereotype mental health issues and psychology. Our country was founded on the colonist spirits of working hard, muscling through and not letting sickness or weakness stop one’s success. Our culture was founded on each person making their own way, being able to sustain one’s self and one’s family — giving to those in need was accepted, being on the receiving end of charity was shunned. These high expectations of the American spirit still hold today. People still believe taking a handout is wrong and those that give the handouts are beneficent and noble.
Admitting one cannot live up to the ideals of one’s culture can put one in distress. It’s hard to realize that one does not measure up to society’s unreachable standards. This is what causes the four stages of adjustment in SSRI use. Our society’s judgment and stereotyping of people puts expectations on the members of our society. Our culture expects others to live up to an unattainable standard and that is what makes an individual view their need for an SSRI as not only a comment on themselves, but also as comments on their weaknesses, ailments or inabilities. Instead, the judgments, stereotypes of society, the internalized oppression, the unreachable expectations, and the drive to be perfect are never examined for what they really are: comments on the unbending and uncompassionate nature of our society.
References
Deacon, B. J., & Baird, G. L. (2009). The chemical imbalance explanation of depression: Reducing blame at what cost? Journal of Social and Clinical Psychology, 28, 415-435.
Gotham Artists. Ned Vizzini. Gotham Artists. Retrieved from http://www.gotham-artists.com/ned_vizzini.html
Knudsen, P., Hansen, E. H., Traulsen, J. M., & Eskildsen, K. (2002). Changes in self-concept while using SSRI antidepressants. Qualitative Health Research, 12, 932-944. DOI:10.1177/104973202129120368
Mitchell, A. J. (2007, April 1). Understanding medication discontinuation in depression. Psychiatric Times. Retrieved from www.lexisnexis.com/hottopics/lnacademic
Mohr, R. D. (2010). “Anti-Gay Stereotypes.” In P. S. Rothenberg (Ed.). Race, class and gender in the United States. (pp.577-583). New York, New York: Worth Publishers.
National Association of Social Workers. (2008). Code of Ethics of the National Association of Social Workers. Retrieved from http://www.socialworkers.org/pubs/code/code.asp
Oppression. Dictionary.com. Retrieved from http://dictionary.reference.com/browse/oppression?s=t
Sharpe, K. (2012, June 29). “The medication generation.” The Wall Street Journal Online. Retrieved from online.wsj.com/article/SB10001424052702303649504577493112618709108.html
Stigma. Dictionary.com. Retrieved from http://dictionary.reference.com/browse/stigma?s=t
U.S. News and World Report. (2012). Education: Stuyvesant High School. U. S. News and World Report. Retrieved from http://www.usnews.com/education/best-high-schools/new-york/districts/new-york-city-public-schools/stuyvesant-high-school-13092
Verbeek-Heida, P. M., & Mathot, E. F. (2006). Better safe than sorry - why patients prefer to stop using selective serotonin reuptake inhibitor (SSRI) anti-depressants but are afraid to do so: Results of a qualitative study. Chronic Illness, 2, 133-142. DOI:10.1179/174592006X111003
Vizzini, N. (2006). It’s kind of a funny story. New York, New York: Hyperion Books.
Deacon, B. J., & Baird, G. L. (2009). The chemical imbalance explanation of depression: Reducing blame at what cost? Journal of Social and Clinical Psychology, 28, 415-435.
Gotham Artists. Ned Vizzini. Gotham Artists. Retrieved from http://www.gotham-artists.com/ned_vizzini.html
Knudsen, P., Hansen, E. H., Traulsen, J. M., & Eskildsen, K. (2002). Changes in self-concept while using SSRI antidepressants. Qualitative Health Research, 12, 932-944. DOI:10.1177/104973202129120368
Mitchell, A. J. (2007, April 1). Understanding medication discontinuation in depression. Psychiatric Times. Retrieved from www.lexisnexis.com/hottopics/lnacademic
Mohr, R. D. (2010). “Anti-Gay Stereotypes.” In P. S. Rothenberg (Ed.). Race, class and gender in the United States. (pp.577-583). New York, New York: Worth Publishers.
National Association of Social Workers. (2008). Code of Ethics of the National Association of Social Workers. Retrieved from http://www.socialworkers.org/pubs/code/code.asp
Oppression. Dictionary.com. Retrieved from http://dictionary.reference.com/browse/oppression?s=t
Sharpe, K. (2012, June 29). “The medication generation.” The Wall Street Journal Online. Retrieved from online.wsj.com/article/SB10001424052702303649504577493112618709108.html
Stigma. Dictionary.com. Retrieved from http://dictionary.reference.com/browse/stigma?s=t
U.S. News and World Report. (2012). Education: Stuyvesant High School. U. S. News and World Report. Retrieved from http://www.usnews.com/education/best-high-schools/new-york/districts/new-york-city-public-schools/stuyvesant-high-school-13092
Verbeek-Heida, P. M., & Mathot, E. F. (2006). Better safe than sorry - why patients prefer to stop using selective serotonin reuptake inhibitor (SSRI) anti-depressants but are afraid to do so: Results of a qualitative study. Chronic Illness, 2, 133-142. DOI:10.1179/174592006X111003
Vizzini, N. (2006). It’s kind of a funny story. New York, New York: Hyperion Books.
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