I’ve been a therapist for over 10 years now and one of the most challenging conversations I continue to have with clients is about psychiatric medication. When I tell clients that I think they might benefit from such a medication – to improve their mood or to address other mental health symptoms – I’m often met with some combination of hesitation and downright resistance to the suggestion. Yet, my client’s reticence is often based on little more than a vague sense of dread about these medications. I think there’s a serious lack of public education about these drugs and, in the absence of solid information, people fill in the gaps with things they’ve heard, personal anecdotes, and other people’s opinions. Yet, as I’m fond of telling my clients, not all opinions are created equal.
One of my Facebook friends recently posted a video, which pointed out many of the people responsible for committing mass shootings, over the last several decades, had been treated with psychiatric medication prior to committing their crimes. This accurate observation – people who commit mass shootings are more likely to have been treated with psychiatric medication than the population as a whole – demonstrates what’s called a correlation.
A correlation is the idea that two or more variables, in this case a person’s psychiatric medication use and whether or not they will commit a violent crime, are connected in some way. From this observation, the video drew the conclusion that psychiatric medication use must be the variable responsible for driving individuals to commit a violent crime. But, herein lays the problem. Correlation does not equal causation.
Psychiatric drug use is one variable, which might be causing individuals to act on their homicidal tendencies, but it doesn’t necessarily mean that it is the right one. Another equally plausible explanation for the observed correlation is individuals who commit a violent crime often have severe mental illness and receive some type of pharmacological treatment for their illness prior to committing their crimes. In this case, the mental illness would be the variable responsible for both the psychiatric medication use and the homicidal acting out. For a more thorough description of the difference between correlation and causation, check out the following link: https://www.iperceptions.com/blog/causation-vs-correlation
I often see people making decisions about psychiatric medication based solely upon anecdotal information, my-friend’s-co-worker’s-cousin’s-son-tried-medication-X-and-had-a-bad-reaction variety. I think we rely on these kinds of anecdotes in the absence of more research-based information. Anecdotes have value, but it’s limited. The problem with anecdotes is that they are individual case studies and they don’t give you any information about how often these kinds of results occur. There is no such thing as a medication that never has side effects or works for 100% of the people who take it.
But, if adverse reactions are relatively common, then that’s important information to know, too. Having a basic understanding of how research studies are conducted is so important. With this understanding, you can evaluate how well or poorly constructed a research study was and whether or not the study’s conclusions are worth accepting.
Similarly, I often hear people make comments to the effect of, “There are so many research studies out there and they all say different things, so how am I to know what’s true and what’s not.” This is a very valid frustration. Yet, the right conclusion is not to throw one’s hand up in the air, in despair, and assume that we’ve got no way of knowing what research is worth reading and what’s not worth the paper on which it’s printed.
If you’re serious about understanding how drugs are researched and about evaluating how valid the conclusions of research studies are, then you’ll need to brush up on your understanding of statistics. To evaluate the validity of a research study, one must consider such factors as: 1) whether or not the study was published in a peer reviewed journal, 2) the study’s measures of reliability and validity, 3) issues related to sampling, 4) potential conflicts of interest among the researchers, and 5) who funded the study – just to name a few. To learn more about evaluating the quality of research studies, check out these links:
http://sites.psu.edu/kmh6360/2017/04/03/how-to-know-if-a-research-study-is-reliable/
https://www.elsevier.com/connect/how-do-you-know-if-a-research-study-is-any-good
https://thelogicofscience.com/2015/08/03/10-steps-for-evaluating-scientific-papers/
To be clear, I’m not saying psychiatric drugs are the cure for every mental health issue. I have seen medication provide profound relief and improved quality of life for hundreds of my clients over the years – both adults and children. I have also seen people have adverse reactions to psychiatric drugs, some severe. Severe reactions have been rare and many of the more mild reactions have resolved themselves over time. Ultimately, what I can say is that, both in my own personal experience and in my clinical experience, I have seen psychiatric medications do far more good than bad.
