All of the “common beliefs” or conceptual errors listed below essentially stem from a mistake in how the issue is framed. The mind—and therefore thoughts, behaviors, and moods—is an expression of brain activity, and ultimately of the whole body, but with the brain acting as the “control center.” Yet when people think about the mind and behavior, the brain is the “great absentee.” Even people who seek medical treatment may reason as though it were not clear that medications act on the brain, and that symptoms, disorders, and their course originate in the brain. When people think about their own brain, it is as though, on the one hand, they do not consider the brain to be the fundamental source of mental manifestations, while on the other hand they imagine that they possess some kind of “spiritual” brain that can somehow activate itself and command the diseased brain from above, making it move, recover, avoid becoming ill, and so on.
1. Medicines treat the symptoms, but that is merely an illusion; they do not solve the problem at its root. Psychotherapy does that.
Medications and psychological techniques are tools aimed at the same objectives, using different methods. Above all, it is important to know what each of them is suited for and what it can actually do, disorder by disorder, rather than thinking about them “in general,” and especially not as if they belonged to completely separate “worlds.”
It is false both that medications do not treat the problem at its root and that psychotherapy, by definition, does. There are superficial and profound treatments of both kinds, and their depth does not depend on the method, but on what is being influenced.
If we really want to talk about levels of depth, at the surface level there are environmental interactions; beneath that are brain structures, including stable modifications produced by environmental factors (epigenetics), assuming we know what those modifications are; and at an even deeper level is the original genetic makeup.
Medications can influence the first and second levels, and therefore have a therapeutic effect, but they do not influence the last one.
2. Medicines cannot do much when distress comes from negative events or experiences.
For the same reason described above, this idea is wrong. Medications influence a level of brain functioning and plasticity that is common to both disorders based on a pre-existing “genetic” vulnerability and disorders that develop through the influence of external factors. There is therefore no fundamental difference between the two.
Furthermore, the causal link is rarely decisive for diagnosis. In predicting how a disorder will develop and evolve, it matters relatively little whether it began “after” or “during” a particular period of life. It is much more important to know how it manifests itself, which symptoms are present, and what its course is.
3. Medicines cannot possibly change the way we think.
This is a typical example of failing to take the brain into account. Medications that act on the brain obviously modify its functions, and thought, including both its forms and its contents, is a mental function.
So why should medications for psychiatric conditions not be able to affect thought through their action on the brain?
4. Medicines change your personality.
For some people, this is a general fear of losing control over their own mind, as though medications might alter their mental characteristics so profoundly that they would no longer recognize themselves, no longer feel fully present to themselves, and so on.
This is typically an obsessive fear. It is not really a specific belief about medications, but rather a fear of anything that cannot be completely controlled, or of the possibility that a chemical effect might become irreversible.
For other people, however, the idea is that in order to obtain the desired effect, medications somehow flatten everything. In this case, the idea may come from poor sources of information or from misunderstandings about the type of medication involved, and above all about the illness for which it is being taken.
This is one of the situations in which the term “psychiatric drugs” creates more confusion than clarity, because it is obviously impossible to discuss the effects of medication without specifying which molecule, for which problem, and starting from what clinical situation.
5. Psychiatric drugs are addictive, or even worse, they “create” addiction.
These two ideas are extremely widespread, to the point that some people regard them as established facts.
The idea might make some sense if it were referring to certain tranquilizers. In reality, however, the argument is rarely limited to those drugs and is instead applied generically to the concept of “psychiatric medication.”
If one does not consider the existence of a brain that can become ill, someone who receives treatment—perhaps for a long time, perhaps for life—because they suffer from an illness that otherwise repeatedly returns may begin to feel as though they are being held hostage by medication.
If they do not take it, they become ill again; if they take it, they feel well. Therefore, the illness is somehow “the fault” of the medication.
This paradoxical way of thinking comes precisely from an instinctive refusal to accept that the enormous complexity of thoughts, emotions, and behaviors can arise from that thing inside the skull: the brain.
Unfortunately, this reversed way of thinking is often followed by behavior such as: “If I stop taking the medication decisively, I will free myself from the illness.” This choice is responsible for many relapses and can often make the illness worse. The person tries to manage on their own or is willing to do almost anything except restart the medication, because even while feeling unwell they believe that stopping treatment was a major step toward recovery.
A double misunderstanding occurs when people are being treated for dependence on drugs or alcohol. They may say that taking medication means simply replacing one addiction with another, as though the problem were “taking a substance,” rather than the actual distinction between being intoxicated by a substance without control and being well and balanced while taking a substance.
Again, the brain is not being used as the measure of what is happening. The focus is instead on the mere fact of “taking something,” rather than on how the person is functioning.
6. There are studies showing that antidepressants are actually placebos.
This type of claim takes one or two studies concerning a specific type of medication in a specific situation and extends the conclusion to everything.
It ignores the fact that before a medication is placed on the market, it undergoes multiple trials involving many people. And once the drug is on the market, there are years and years in which it becomes possible to determine whether it actually works or not, even assuming that some of the original data were inaccurate.
It is paradoxical that every finding unfavorable to the efficacy of an antidepressant is loudly presented as proof that “psychiatric drugs are a scam,” while at the same time countless over-the-counter products with vague and indefinite claims such as “useful,” “helps,” or “may support” are viewed favorably when they are marketed for generic conditions such as anxiety, stress, malaise, weakness, and so on.
7. Nobody even knows how antidepressants work. The studies prove it, so they must be a scam.
This “revelation,” often made by people who conduct scientific research online, is based on a misunderstanding.
First of all, one must distinguish a particular molecule administered at a particular dose. And uncertainty about the mechanism of action does not in any way invalidate evidence of efficacy.
It is possible not to know why something works while still knowing that it works.
This may seem strange, but these are two different questions. The mechanism of action, when a phenomenon cannot be examined in real time and under natural conditions, is always partly uncertain.
Determining whether a stimulus—such as a medication—is associated with an effect—such as improvement—requires studying a sample of people, and this does not even require having a prior hypothesis about the exact mechanism.
Indeed, many medical discoveries occurred by chance, while researchers were looking for something completely different, simply because they noticed that people taking a particular medication experienced beneficial effects of another kind.
8. I cannot tolerate medications.
Taken literally, this statement makes little sense, because medications have such different mechanisms that there is no single common basis for “not tolerating medications.”
The problem is therefore likely to be related either to the person’s condition, making them particularly sensitive at first to certain classes of medications, or to anxiety about experiencing side effects and the fear of losing control over their body or brain.
Alternatively, the person may actually be unable to tolerate one particular type of medication, but that does not mean that other medications with different mechanisms are unavailable.
Furthermore, “not tolerating” a medication is not the same thing as experiencing an initial worsening. Initial worsening is, in fact, relatively common before a therapeutic response appears, usually after about a month with antidepressants.
9. What exactly are these medications supposed to do to me?
This question is harmless in itself. I mention it only because it is another example of failing to think of the brain as part of the equation.
The person describes all of their symptoms in detail and then, at the end, asks what exactly the medication is supposed to do.
The apparently obvious answer—“it is supposed to make the symptoms go away”—is not entirely obvious because, while describing their symptoms, the person sees them as expressions of their own mind. The medication, however, acts on the brain, and the relationship between the two is unclear to them.
10. Am I better because of the treatment, or because perhaps I have learned how to cope?
This is, in a way, the mirror image of the previous line of thought, but after treatment.
The improvement may indeed be due to the treatment, yet the person is inclined to make the same kind of assumption as before: that some mysterious “reserve brain” has suddenly become active, even though for unclear reasons it had not been functioning before.
Likewise, some equally mysterious force of willpower or desire to react is imagined to have switched it back on. The medication may have “helped,” perhaps, but fundamentally the real effect is assumed to have been a “psychological” one operating at some other level.
All of this ultimately leads back to one point: we are talking about the brain.
There is no need to argue that we are “not just our brains,” but also our environment, personal history, and everything else, because our personal history and environment pass through the brain—and, in fact, they can sometimes change along with the brain more than the other way around.
Our functioning influences the way we seek out and carry out our interactions. A “trauma,” for example, may depend both on what happened to offend or harm us and on how predisposed we were to experience that particular event as an injury.
This blindness to the brain as an organ, and to the mind as its expression, is responsible for a whole series of misunderstandings. These range from statements and common beliefs—sometimes even amusing ones, which then become subjects for discussion and explanation—to genuine controversies portraying psychiatry as an excessively “biological” or “organic” discipline.
On this point, it is possible to exaggerate everything except one thing: psychiatry deals with brains. And when psychiatry deals with relationships, experiences, and social dynamics, it is still dealing with brains—studying other pathways through which the brain functions.