Possibly one of the most controversial topics in mental health is the use of medications. I’m sure most of you have seen that photo that goes around facebook periodically; a beautiful wooded grove with the caption “this is my medication.”

If that’s all the medication you need, wonderful! You’re one of the lucky ones.

But unfortunately, that isn’t sufficient for most sufferers of mental illness.

At the same time, it’s dangerous to assume taking a prescription every day is going to fix everything and suddenly make you feel better. Medication simply helps balance your brain chemistry. Proper treatment of mental illness must include consistent use of any prescription medications, therapy, and a healthy lifestyle. A healthy lifestyle isn’t limited to diet and movement, but also journaling, meditation, consuming uplifting media, avoiding toxic people and media, and more.

The stigma around medicating doesn’t only exist in the world of mental health however, but also physical health.

I recently browsed the comments on a post in a facebook rheumatoid arthritis group. One of the comments talked about how she’s used cannabis for years to manage her symptoms instead of prescription medications. She mentioned that she was still weak and her joints continued to worsen, but the cannabis managed most of the pain. Reading this made me want to pull my hair out in frustration. Of course her joints were still weak and worsening, cannabis isn’t an immunosuppressant. It doesn’t to anything to stop the disease from progressing, it only masks some symptoms. It boggled my mind that she could think her self medicating was somehow better than the prescriptions proven to put RA in remission, monitored by a physician. That isn’t to say cannabis isn’t a great pain reliever for many who suffer from chronic illnesses such as RA –but if you understand how the disease works, you know that not being in pain doesn’t mean the disease isn’t still effecting your health.

Many patients stop medicating because they aren’t happy with the side effects. Yes, side effects can be painful, awful, and difficult to live with. One of my RA medications gives me horrible acne that I barely keep under control with prescription creams from my dermatologist. Another one of my RA medications is a chemotherapy drug, and while thankfully it’s a low dose, I still suffer some side effects such as hair loss and nausea. But what’s the side effect of not taking those medications? Joint degeneration, joint pain, migraines, no energy, sleeplessness, severe muscle weakness. And long term –the danger of not taking those medications is a shortened life span.

To treat my bipolar disorder, I take something called lithium. Patients with bipolar are one of the worst offenders for stopping medication.

People go mad in idiosyncractic ways. Perhaps it was not surprising that, as a meteorologist’s daughter, I found myself… gliding, flying, now and again lurching through cloud banks and ethers, past stars, and across fields of ice crystals. Even now, I can see in my mind’s rather peculiar eye an extraordinary shattering and shifting of light; inconstant but ravishing colors laid out across miles of circling rings… I remember singing “Fly me to the Moons” as I swept past those of Saturn…

My family and friends expected that I would welcome being ‘normal,’ be appreciative of lithium, and take in stride having normal energy and sleep. But if you have had stars at your feet and the rings of planets through your hands, are used to sleeping only four or five hours a night and now sleep eight… it is a very real adjustment to blend into a three-piece-suit schedule, which, while comfortable to many, is new, restrictive, seemingly less productive, and maddeningly less intoxicating. People say… “well, now you’re just like the rest of us…” But I compare myself with my former self, not with others… When I am my present ‘normal’ self, I am far removed from when I have been my liveliest, most productive, most intense, most outgoing and effervescent. In short, for myself, I am a hard act to follow.

And I miss Saturn very much.

Kay Redfield Jamison, “An Unquiet Mind: A memoir of moods and madness”

As destructive as mania can be, parts of it are beautiful, exhilarating, and impossible to replicate. But after mania follows the depression. Jamison stopped her lithium many times, despite being a psychologist who studied lithium and knew the benefits and importance of it. She always came back to the lithium when her mania would crash into bitter depression. She had one patient who never would stay on his lithium, and eventually it cost him his life.

I think the most difficult “side effect” I’ve had to live with from medication is my loss of the hypo-manic color in my life. I used to watch movies and read books and really be part of the story. The characters were real to me. Now when I watch and read I can separate reality from the story, and it’s painful. Painfully dull. The stories aren’t as enrapturing. Now I understand why so many stories that shook me to my core growing up were just stories to everyone else. Think of those few books/movies etc growing up that changed the way you saw the world forever. For me, every book and story did that to me. I used to lay awake at night, imagining myself in the worlds I read about –I lived in them. It was so much more than just playing pretend. It was my second reality.

But if I stopped taking lithium, I would be susceptible to the dark side of mania, and to the crushing defeat of depression and suicidal ideation that comes with it.

Thankfully, I remember the painful parts as clearly as I remember the beautiful ones, and that motivates me to be consistent in my lithium intake. However, many who take lithium are constantly tempted to stop, and imagine how much harder it is when they see a little picture of a wooded grove pop up on their social media that says, “this is my medication.” Suddenly they’re thinking, “why can’t that be enough for me, too?”

People say the USA is the most medicated country in the world, as if that’s a bad thing. Maybe we’re the most medicated because we’re the most aware of of mental illness. Or because we have better access to prescriptions than other countries. Or the stigma isn’t as bad here as it is other places. Yes, it is possible to overmedicate, but the USA medicating more than other countries isn’t necessarily a bad thing. Is it so out there to think that maybe most medicated Americans have a legitimate need for those medications? Is it so crazy to think that mental illnesses need medication to be treated properly?

Yes, I take a lot of medications. That picture above is of the pills I take daily. But I’m not ashamed of the medication I take. They keep me from getting suicidal. They keep my RA from progressing. They improve my quality of life. They make it possible for me to do things like shower by myself and be a good mom for my children.

It’s OK that I need medication. It’s OK if you need medication. It’s OK to medicate.