Medicalizing Counselling by Tom Strong

Author:Tom Strong
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

Mood-Altering Substances and Counselling?

Psychoactive substances have always been part of Shamanistic traditions of practice some associate with counselling (Harner 1990; Krippner 2002). Freud (1885) himself experimented with prescribing the use of cocaine for its healing potentials. However, it was not until the years after the Second World War that medications for anxiety (Tone 2008) and depression (Greenberg 2010) began to expand into the ambiguous zone psychoanalysts had deemed “neurotic.” In Greenberg’s colorful language, this was an era in which “depression doctors turned away from biography and back to biology” (2010: 126).

Freud’s cross-over from his start in neurology to conversationally focused psychoanalysis (see Jones 1974) is frequently touted as modern counselling’s starting place. The return back to biology was enabled by etiology-agnostic DSM-III diagnoses; what mattered was what alleviated symptomatic suffering. While medications like Thorazine and lithium became part of the still-counselling psychiatrist’s mid-twentieth-century pharmacopeia for more serious, psychotic kinds of mental disorders (schizophrenia, bipolar disorder) (Whitaker 2010), depression and anxiety medications were usually targeted for use by general practitioners. These new medications for milder “disorders” inaugurated a new, and less conversationally focused “journey into the economy of melancholy,” as Greenberg entitled another article (2007).

While alcohol has been recognized as a form of self-medication for depression or anxiety for centuries (Valverde 1998), and recreational drugs provided related forms of escape for millennia (Taylor 1966), pharmaceutical companies have only relatively recently addressed human miseries. Any discussion of medications or “drugs” invariably requires some consideration of potential abuse or addictive effects (e.g. Booth 1997), but that will not be the focus here. Instead, my interest shall be with how counselling and prescription medication use—most notably use of antidepressants and anti-anxiolytic medications—find potential overlaps, extending to how counselling is influenced by those overlaps. The depressions and anxieties of interest here will be “sub-clinical,” so as to skirt obvious issues associated with severely debilitating depression or anxiety (see Horwitz and Wakefield 2007, 2012, respectively). Our primary focus will remain the “worried well” or “mildly melancholic” potential clients who come to counselling with normal life difficulties (Aubrey 1983; Hahn 1955) or Szasz’s (1961) “problems in living.”

In a popularized New York Times sketch of the history of medication for depression , Mukherjee (2012) cited a serendipitous discovery that occurred in a sanatorium treating tubercular patients in the early 1950s. That discovery—iproniazid—had an observed effect on patients’ moods and behaviors and prompted consideration of how the same effects might be generalizable to other people affected by disturbances of moods and behaviors—or “depressed brains” (Mukherjee 2012). Prior to this time, opioids and amphetamines were used to respond to depressive symptoms (Weber and Emrich 1988). Between the time of iproniazid’s discovery, and the eventual articulation of the neurotransmitter hypothesis (Siever and Davis 1985) that came to inform the development of Prozac, the market for antidepressants was relatively small and focused on the use of “tricyclics” and tranquilizers like valium (Greenberg 2010).

While some researchers clearly wanted to keep symptomatic concerns like depression and anxiety at least partly nested in sociocultural context (Engel 1977), increasingly the cultural and medical focus was turning to the brain.

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