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Tuesday, 19 November 2013

Is shaming the 'pill-shamers' shutting down debate?


‘Whatever is begun in anger ends in shame.’- Benjamin Franklin

Keep taking the tablets. But
maybe keep quiet about it?
Over the past year I've immersed myself in Twitter. Like many I started tentatively, following the usual parade of news sites and comedians. It didn't take long though to realise the value of Twitter for discussing mental health. It’s packed to the rafters with campaigners, professionals and service-users. It’s also, famously, a place where people feel free to say more or less whatever they want. Put all these elements together and the result is a powerful (if dissonant) mix of voices in social media and in mental health.

Recently, some Twitter followers have turned their attention to several articles in the national press which critique the use of psychiatric medication. These articles, one by novelist Will Self, another by commentator Giles Fraser and a third by psychiatrist Joanna Moncrieff, broadly say the same thing: life’s ups and downs are being pathologised and psychiatric drugs are being wildly overused.
These articles angered many and the dissonance on Twitter quickly built up steam. Besides the authors being accused of rehashing clichéd arguments, they were also chastised for trivialising the experience of living with a mental health problem. Above all though, they were criticised for implying that people who take psychiatric medication are weak, stupid or being duped by the pharmaceutical industry. A new phrase (with accompanying Twitter hashtag), ‘Pill shaming’, was coined to describe media articles that make people feel that taking their medication is wrong.

‘Pill shaming’ is an emotive term and one, I think, that may be hard to challenge. It’s grounded in the idea that, for some, medication is the only thing that can make day-to-day life tolerable. That medication can, literally, be the difference between life and death. To be told that such medication is simply part of an elaborate con devised to make money for pharmaceutical companies may be seen as unhelpful at best; and at worst, insulting.

I wonder, though, if the accusation of insulting or shaming tells the whole story. While it’s true that medication is not optional for many people with severe mental health problems, there are also people who perhaps do have some choice and who should be questioning whether medication is the right option for them. Medication comes with some nasty side-effects and is not always the best solution for everybody. There are people who, for example, are given antidepressants when bereavement counselling, therapy or self-help groups might be more helpful. Others might find that lifestyle and diet changes are enough to make them feel better. Is it shaming to suggest this?

The three articles that sparked this debate perhaps make some poor choices of language. The tone of Giles Fraser’s article seems to play down the burden of living with depression, and readers of Joanna Moncrieff’s article may feel alienated by phrasing such as ‘zombie’ pills and ‘the newly fashionable diagnosis of bipolar disorder’. However, the articles also make some important points that seem to have got lost in the Twitter storm.

Giles Fraser’s piece raises concerns that social and economic factors that affect wellbeing are overlooked. This is a completely legitimate point. We probably should be wondering why, for example, prescribing for ADHD medication is rising steadily or about the reasons Afro-Carribean men are more likely than other groups to be diagnosed with a severe mental health problem. Perhaps there are other avenues of help to be explored?

Will Self’s article reminds us that the criteria for mental health diagnosis often emerge based on the conventions of the time (famously, homosexuality was a mental health diagnosis until 1973). This doesn’t mean to say that the suffering associated with psychological distress is not real, but that perhaps the way we talk about mental health can be unhelpful. This has links with the recent call by the British Psychological Society for a paradigm shift in how we understand distress.

Joanna Moncrieff argues that the evidence base for psychiatric medication may be misrepresented and that the way that medication is ‘sold’ to us may be misleading. We are, for instance, told that antipsychotic medication targets the ‘psychotic’ elements of the brain chemistry when perhaps it would be more honest to think of it in terms of a more general sedation, one of the effects of which is to tone down the impact of so-called psychotic experiences.

The questions these writers raise are worth asking, even if the way they might be asked offends some. I do worry, though, that strong reactions to critiques of psychiatric medication shut down important debates before they’ve begun.  Of course, people shouldn’t be made to feel ashamed to take medication to cope with psychological distress. And of course, there is a right to call people out if they feel that this is happening. But maybe it’s counterproductive to bring the full force of Twitter down on anyone who criticises the use of psychiatric medication. That too is shaming.


We are aware that this issue has prompted many strong views. We would therefore be very interested in your opinions in the comments thread below. Leigh has agreed to be available to comment and respond over the next few days. You can follow Leigh on Twitter @SafeUncertainty. (Eds.)

21 comments:

  1. Completely agree with the fact that such debates should not be shut down before they have started. Psychiatric medication has its place and is extremely useful for many individuals with mental health problems; however psychological therapy is there for a reason, to understand psychological distress better and to consider ways of coping that works for the individual, in the hope that medication may eventually no longer be required.

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    1. Agreed, although therapy also has its limitations and is not for everyone. What works for people is a very individual thing (though research points out what is most likely to help).

      My main concern is that we might start to feel too uncomfortable question medication use because we don't wish to be accused of shaming the people who take them, or that our opinions gets lost if we DO question medication use.

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  2. We desperately need to have these discussions. I tend to prefer it done in a manner that includes more than 140 characters but, in my opinion, it's a great place to start! I think *any* springboard to discuss all the facets of mental illness and treatment is necessary. I also think it behooves those of us with something to say about it to continue the debate when we see it heading toward shut-down. While there is the assumption that 140 characters equates to a short attention span, I think that if we engage in educated, passionate and open-minded dialogue, we can change in both the stigma and the treatment spectrum.

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  3. re: "I do worry, though, that strong reactions to critiques of psychiatric medication shut down important debates before they’ve begun."

    I'm not sure how twitter reaction is shutting down the debate. The Guardian has a fondness for running anti-medication pieces, I'm not convinced a single twitter hashtag will change that ethos.

    On the other hand, if a twitter hashtag makes writers think more carefully before using stigmatising cliches ("zombie" or "happy pills") then that seems good for everyone. You rightly point out that people who take meds do feel stigmatised -- reducing lazy language would help counter that. And if a critique needs to include lazy characterisations to add weight then there's something wrong with the critique and it won't do much for the vital (and complex) debate about which interventions work for whom.

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    1. Thanks for commenting.

      You're quite right that terms such as "zombie pills" are likely to make those who take meds feel stigmatised, and I agree that when people feel stigmatised they have every right to speak out about it. However, I also feel that a strong reaction on social media against such articles might have unintended consequences of preventing side of the debate that questions medication use from being heard.

      I agree that a single Twitter hashtag might not change much, but from what I saw there was much more than that going on in social media. When, for example, Giles Fraser's piece was published, there were a number of rebuttals from blogs as well as on Twitter. from what I could tell, the focus of these was very much on Giles Fraser's apparent dismissiveness of the experience of mental health. It's fair to point this out, but he also made some good points about how socioeconomic factors can be overlooked in a diagnostic-heavy culture. This was followed up far less in social media, meaning that we lose out on important debate about the way we prescribe and use medication.

      I'm not trying to defend the language these articles used, and believe that if the articles had been worded more sensitively then they might have been more productive. However, I'm concerned that outright dismissal of these articles as Pill Shaming might throw the proverbial baby out with the bath water.

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    2. Hi Leigh, thanks for the reply. I think part of the problem is that a single, service-user created hashtag is being seen as "the full force of twitter", which is not the case here. Although twitter does have a big reach when it's in full force, this small #pillshaming example really doesn't register at all when it comes to platforms the size of the Mail or The Guardian. Neither of those papers is going to stop publishing anti-medication pieces any time soon. So I'm still not clear who exactly the hashtag is shutting down -- rather it seems to be giving a voice to a small group of unrepresented service users who want to protest about lazy tropes used in sweeping anti-medication pieces.

      The Fraser piece did garner a lot of rebuttals from bloggers, but again I'm not sure how service user bloggers rebutting a point is the same as "shutting down" a debate, surely they're adding their voices to it?

      I take your worry that the more valid points of the articles are being overlooked because of the articles' lazy points, but I do think that means the onus is on the writers, and their editors, to sharpen up their pieces and weed out old and stigmatising cliches. #pillshaming is not (in my experience of seeing it) used to dismiss all arguments against medication, but rather is an expression of tiredness and frustration at lazy points. I think the tiredness aspect is worth emphasising -- it's not the case of wanting to shut down the debates "before they've begun", these debates have been around for a long time, and will continue. Personally, I'm glad that social media now gives a voice to those with lived experience of the issues, who want to raise awareness of the particular stigmatising aspects of anti-medication narratives. If people who actually use meds can't be heard in the medication debate, then important voices are missing.

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    3. Perhaps you're right that "the full force of Twitter" is a bit of hyperbole, but I think you're selling the Twitter community, and #pillshaming, short.

      Maybe you're right that large media outlets like The Guardian are unlikely to stop writing a particular type of article because of a Twitter protest (although I suspect Giles Fraser will think twice before writing about mental health). However, discussion among mental health professionals, service users and the general public emerges out of these national articles, and it's this that I'm worried is getting shut down. When I first saw the #pillshaming hashtag, it didn't quite sit right with me (for reasons I've outlined above) but I didn't feel able to speak out against it. I hesitated to write this very blog entry. And #pillshaming is part of the reason for that hesitation: I didn't want to feel that I was stigmatising or shaming people. I think the hashtag had more influence on the discussion than you're giving it credit for.

      Of course, I understand that this is not the intention of #pillshaming. I understand that people are tired of lazy cliches, and it's very reasonable that people who feel that frustration should speak out about it. However, a potential (unintentional) consequence of a strong reaction such as #pillshaming is that the debate is less open than it could be.

      You do raise an important point about where the onus lies. Writers should be sensitive in their language whenever they write about mental health problems, and the above articles fall short of that at times.

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  4. The problem is one of ambiguity, imo.
    When people say a drug "works" for them, do they mean it in the technical sense, or a "I don't feel as bad" sense? .... that matters hugely.
    The mechanisms by which the drugs "work" are unproven, and there is no scientific way in which dosage can be determined. The drugs are doled out with a lets-see-what-happens type approach..... a few uppers, and a few downers. Many of us have been and seen zombies on those drugs (shorthand for people drooling themselves, staggering walk, eyes half shut, and slurred speech)
    For me, the issue is when people do as if drugs *are* the solution, that they treat the problem. They do not. Science & medicine should be evidence based - but psychiatry and it's drugs manages to be in those schools without proper methodology. Medication should be based on sound science, not anecdote.

    I do not believe anyone is trying to deny others drugs, nor to make them feel ashamed for taking them. However, there are people trying to make others feel ashamed for *not* taking them, and in many states have the power of law to force them to do so.

    Shame is completely voluntary.

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  5. Angela Gilchrist, Clinical Psychologist20 November 2013 at 11:18

    I'm highly sympathetic to those at the moderate to severe end of the scale, who find they have little choice but to psychiatric meds if they're to keep functioning in any way at all. I don't think that's where this debate is, though. Its really about asking whether there are alternatives for those on the mild-moderate end of the spectrum. Also, I think its legitimate to question whether labelling certain responses as 'pill-shaming' has the impact of shutting down the debate. We need an atmosphere of free inquiry in which there are no sacred cows.

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    1. Agreed. As I've mentioned, there are people for whom medication is not an option, and there's no denying that medication is an effective (if perhaps blunt) tool. For other people, however, medication is presented as the only tool, when other approaches might be effective. Labelling this kind of discussion as pill shaming may well prevent these interesting avenues of discussion from developing.

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  6. I agree.... and in the spirit of debate, I think it is also important to question what is meant my the moderate/severe ends of the scale. Part of the problem is that there is no actual scale, nor any true objectivity. I wonder, in my bad days, where I would have fitted on an imagined scale. Grand delusions of being Jesus, etc; living in my own reality, being taken in to locked wards by police?
    I wrote the above comments yesterday, after my brother's inquest. The pathologist's deposition was interesting: Lungs - normal weight, no abrasions; Heart - normal; spleen - normal; liver -normal..... the only drug in his system was a psychiatric drug - not toxic and not "therapeutic" levels.
    She did not mention his brain. She reported that medically, he was *normal*. Nothing could prove otherwise when he was alive, and nothing can prove otherwise now that he is dead. [In case your interested, I will blog about this topic on my site (CreativelyMaladjusted.net) when we get the official inquest report]
    When people refer to the "medical" or "bio" model, they do as if there is evidence for it, but as a psychiatric professor proclaimed at a debate here in Ireland, "certainly, at an individual level, we're not going to be able to investigate what is wrong with somebody using an investigative test, but.....". Huh? No tests? None? And you claim to adhere to science, and *even* to medicine?
    That is the issue. It is the reasoning - the science - behind taking the drugs.
    Do many people feel more able to cope on drugs? Yes. Do they change perceptions? Yes. Are there side-effects? Yes. Is there sound science behind them? Inclusive at the very best, more likely no.
    Should people take them? Their choice.
    Where does the shame come into it?
    (aside: it's also interesting to note that writer looking for debate is only contributing to agree with people)

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  7. A couple of thoughts after reading through the comments and the Twitter debates. Medications is, I think, only part of the issue. I am acutely aware though that opinions in this area are very deeply held, there are huge differences and extreme polarities of view. Including, of course, among those who have used mental health services. For some diagnosis is validating and medication life-saving and I appreciate that the articles referred to clearly were difficult. For others diagnosis, medication and the elements of a system which frames distress though a lens of health and illness is distorting and de-humanising.

    I wonder if there is another important issue about your article though Leigh. One which I think is difficult to address. It really pivots around Angela Gilchrist's comment above about free enquiry and no sacred cows. It may seems strange to say but it sometimes appears that service users views are can be held in a position in conversations where they are difficult to challenge in the way that views from others may be. This is likely absolutely unintended but I do think it is real. A product I'd argue of the difficulty of knowing how to respond when someone brings pain to with them. As one quick example, some of the Twitter responses to this article appeared to move into fairly straightforward slagging off quite quickly. (Not, I hasten to add, from anyone I recognise as having contributed to this thread). Perhaps this is inevitable when really powerful feelings are stirred up, but my point is that no-one appeared to challenge it. I think that's simply because it’s hard to. Much easier to stare at your feet rather than engage with a point when you worry that someone may not be able to cope with what you want to say. Whether that expectation is valid or not is another issue, I would argue it’s an anxiety many professionals hold. The really dangerous part of this is, to me, that professionals end up marginalising or ignoring service user views they don't like (or which are expressed in a way that’s difficult) partly because they feel (rightly or wrongly) that such views can’t be challenged.

    I think the most important element of Leigh’s piece is that it is courageous. I don’t use that word lightly and I’ll explain why that’s my feeling. He has tried to analyse and examine an issue that’s controversial on his view of it’s merits rather than treating is as a view of service users or psychiatrists or psychologists or any other group. The gist of one of the comments on in the twitter debate was something like why is this article coming down against a service user led protest. I suppose I’m wondering if the fact that pillshaming was a service user campaign should leave it any more or less open to questioning than anything else. One may or may not agree with Leigh’s analysis or phrasing (in fact above he seems to disagree with some of his own phrasing!) but it does represent a serious attempt to look at the issue. He has clearly found something that made him uncomfortable about the pillshaming campaign, and in particular one or two of the articles associated with it. He has tried to unpack that feeling and think a bit about it. I think it took courage to do that, especially as he was aware of the responses doing this might stir up.

    I’d be very interested in the views of Chasing Data and others. In the end I’m with Ingrid Oliphant. These feel like discussions that are necessary. (John McGowan)

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  8. Hi, thanks for your reply. I agree that open debate is essential, and can see why some professionals are worried that #pillshaming might potentially be used as an indiscriminate card against any and all critiques of medication. However, a worry is not the same as evidence that it's actually happening. Indeed, there is no evidence for this at the moment e.g. no evidence that either "the full force of Twitter" is being employed, nor that the hashtag is being used against "anyone who criticises the use of psychiatric medication", nor that the press is being silenced -- especially on the day when The Guardian tackles antidepressants with (1) a lead story, (2) a Comment, (3) a data blog, (4) video, (5) user responses. And note that the hashtag hasn't been deployed against the coverage.

    Given the worries of the piece haven't been backed up, I remain concerned that Leigh's piece jumps to a stronger rhetorical conclusion ("That too is shaming") than is warranted by what is happening in reality.

    It's interesting that Leigh refers to an initial hesitation on speaking out about this hashtag. The issue of when, and if, and on which platform, professionals and trainees should challenge the narratives of, and "strong reactions" of, service users (and on which grounds) is a complicated one. I'm sure different people will draw the line in different places (which would make for an interesting blog in itself). Personally, I'm concerned that service users are being asked by professionals to moderate their "strong reactions" (if this is what indeed being asked in the article), even though the article does a good job of articulating why those strong reactions are justified. This seems to me to be a problematic position.

    It's worth remembering, too, that narratives about psych medications that contain stigmatising elements really do come from a very broad spectrum of positions (Fraser, Self and Moncreiff have little in common) and not just in the press.

    Given med users face a lot of static about their med use, from a range of positions, I think perhaps it's not surprising that an anti-stigma protest has finally materialised in the form of a hashtag.

    And of course now the protest in turn is being contested, here.

    I may revise this opinion at some point, but for now I wonder whether this protest could have been let go, without contesting it here, even if it made some uncomfortable. I was uneasy about the criticism of Fry's narrative in an earlier post here, though at a pinch I can see he's a celebrity with several big platforms, and so in some sense fair game. But now that this professional blog is using its platform to come out against the protest of a small number of service users I'm getting uneasier still, particularly when some of the main points of the article (that the press might be silenced, or that all anti-medication narratives might be be challenged) are in my view wrong,

    There are, as you say, strong views on all sides of the dx/medication debates. When, how, and where the views of service users should be challenged by professionals (and with what explicit aim those challenges are made) is something that I think is worth unpacking, But bearing in mind that many clinical psychologists are already contesting mental illness, and dx, and the specific effects of meds, John's suggestion that service users who find those things helpful aren't being challenged enough by clinical psychologists on an individual level is perhaps a step in the wrong direction.

    Thanks for your reply.

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  9. Speaking as someone who has experienced several lengthy psychiatric hospitalisations and was once prescribed 28 pills a day; I'm feeling a bit uncomfortable about what chasingdata seems to be saying here. I'm hearing something, I think, which suggests that service user narratives can't/shouldn't be challenged by professionals and trainees. That the feeling even extends in part to someone like Stephen Fry, despite the fact that he is the current President of Mind, seems astonishing. Indeed, it might be harder to challenge user views than is traditionally thought, as there seem to be worries about vulnerability which can make it hard to have frank discussion. This assumption of 'delicacy' surely isn't in the interests of users at all? On top of that, though, there is also a feeling that whatever users choose to say must be 'right' and cannot be contested. I also think its problematic when some users choose to speak for all users, as there is a vast array of different service-user perspectives out there. Surely what is needed is an open and free debate to which everybody feels comfortable to contribute? I was told that I would always be disabled by bipolar mood swings and that I would always need those pills. That proved to be wrong. I take no pills now, and haven't been in psychiatric care for 23 years. I would never have discovered alternatives if I hadn't had the gumption to challenge psychiatric orthodoxy. Reading alternative opinions in the Press and hearing those who had different viewpoints was an essential part of that process. Surely, though, the challenges need to come the other way around, too, or else service-users and professionals will never find ways forward together. It leaves me wondering what it is that people are afraid of? Perhaps some fear losing a voice that seems to have been hard won. I doubt that its possible for that to happen at this point in our history. In my view, congratulations Leigh Emery for opening up the debate and highlighting an important issue.

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  10. Yes I'm also concerned. It does seem that one set of discourse is a somewhat privileged position. I do appreciate how it looks from your perspective Chasing Data and it is good to hear it. I am troubled by the though though that yes we should have open debate but just not about this. Which seems like the implication of what you are saying. I was also worried, not exactly by the pillshaming campaign but more by the tone of one or two (not all) of the articles associated with it. They really seemed to be about closing things down. That seems to me to be worth highlighting as the original pieces made important points.

    I don't think I'd ask that service users moderate reactions. I'd rather ask that professionals find a voice to challenge those things when they see issues of concern. I think Leigh has done this. If professionals don't it's treating all user contributions with kid gloves. (Plenty of friends and colleagues who have used services have indicated to me that they find this patronising in the extreme incidentally). I'm with interested in Fay's response that she was helped by free debate. (John)

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  11. BTW I'm also interested that it was an anti stigma protest. Sometimes I worry that the main response we have as a society to stigma is to get very into a narrative of illness. It's very much the in Time to Change. I'm not sure that challenging that automatically equates to being stigmatising.

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  12. Hi Fay and John, I completely agree with Fay that there are a very wide range of user/survivor perspectives. I think all aspects of the debates would strongly benefit from as wide a possible range of user/survivor voices. It's great that blog sites (including this one) and twitter have given lots of people with lived experience more of a voice. I'm all for that.

    How professionals should interact with the myriad of blogs and tweets out there is a complex question. I am certainly not saying that service users should be treated uniformly as 'delicate', nor that service user views should never be contested.

    But if we are going to have debates, lets have debates where the question is clear, and the evidence each way is actually discussed.

    As I've said before in this thread, I was pleased that Leigh's article didn't challenge lots of the major issues raised by #pillshaming: e.g. lazy tropes about medication do exist, and can be unhelpful. Accepting those points, the article could then have led into a debating question such as "how can writers/professionals best make their points about medication?" and then debated what the lazy and stronger points are. That would have been an interesting debate, and the challenge of the piece would not have been towards service users, but towards journalists/professionals, and the call for what was being asked (sharper arguments) would have been clear.

    As it is, the actual (rather than hypothetical) article leads with the debating question: "Is shaming the 'pill-shamers' shutting down debate?". This question is avoided for most of the article, which covers the problematic aspects of the press stories, and then reiterates some of the press-points the author agrees with. Only in the final paragraph do we return to the debating question, and the question (rather than being debated) is simply answered with: "I do worry, though, that strong reactions to critiques of psychiatric medication shut down important debates before they’ve begun." And that's that -- #pillshaming shuts down debate, though there is no evidence put forward to support this.

    So in my view, it's not really a debate at all. The article simply asserts in one sentence that strong reactions shut down debates, and the take home message for service users is that using the full force of twitter against all critiques (which is not happening in reality) is shaming.

    John wrote: "I am troubled by the though though that yes we should have open debate but just not about this."

    I hope I've made my point that this article isn't actually open debate at all, or at least not a debate about the question that is posed on the title. Again, I'm glad Leigh picked up problematic aspects of the press articles, but the "shutting down" side of the argument hasn't been made. So a reader sympathetic to the hashtag, as I am, is left uneasy as to what the message of the piece actually is.

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  13. I think that one of the biggest issues with mental health, and the one that seems to be largely ignored in favour of petty arguments that merely skirt around the edges, is the complete lack of facilities and practitioners at all levels. Emergency Crisis Teams are hugely undermanned and in some places don't exist. There are such limited places for longer term mental care that it take an extreme act to get someone in dire straights the help that they need, and this is repeated across the country.

    It is highly likely that there is more over-medication than there should be. How else do you deal with people who are unstable and need help when there is none, or it will take 6 months for them even to be assessed? When you can see them falling apart in front of your eyes? What do people expect GPs to do? In the case on mental health drugs the pharmaceutical companies don't need to lift a finger. Often, there is no choice but to medicate.

    I know 3 or 4 people with real life mental health problems. Not a fashion statement, or feeling a bit down, or a new fad ill, but long term issues. None of them want to be taking the medication because the side effects are dreadful. But what else do you do when you know that your CPN is covering half a county and there is no emergency response on a weekend. Do you put of suicide until Monday? Can you just hang on to not overdosing until someone can answer your phonecall? It's okay kids, Mummy's just having a bit of a breakdown. She doesn't mean to scream and shout and smash the place up.

    Everyone knows the real problem. More properly served hospitals that deal specifically with mental health. More practitioners - especially on the front line. More facilities for patients who need a break. REAL help. Not locking people up, but being there for them. Allowing their families a break. Helping them to manage themselves with less or no mediation because you can give them time and space and confidence.

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  14. Chasing Data, I’m sorry if you feel that I’m saying service users should be moderating their reactions. That’s certainly not what I was trying to say. However, I think that pill shaming has a greater effect than simply expressing frustration at sloppy language in the media, which is what you seem to be saying. As I understand it, pill shaming means “shaming someone for taking pills”. Yes, this includes sloppy language and references to “zombie pills”, but the term by definition can (and to my mind does) extend to any article which implies that medication might not be all it’s cracked up to be, however sensitively written.

    I strongly support the right to protest, but I also strongly support the right to openly debate important issues. To my mind, pill shaming is enormously effective at the former, but it sits uncomfortably with me because I think it impedes on the latter. For example, there’s a debate to be had about the influence of the pharmaceutical industry on the prevalence of psychiatric medication, but that debate cannot openly happen if it is dismissed as pill shaming. It has the potential to make some topics taboo, and I don’t think that that’s helpful.

    It seems from your responses, though, that if I am to challenge this, I should only critique journalists and columnists, but that I should not critique service users. I don’t mean this to sound like I’m gunning for SUs (far from it), but I do think that SUs should be under the same level of analysis and/or critique as anyone else who has something to say on mental health issues. You're quite right, though, when you say that there could be a very interesting blog entry (and a lively debate) about the ways in which the press talk about medication.

    I’d also like to pick up on a couple of the more specific points you made. You said:

    “Indeed, there is no evidence for this at the moment e.g. no evidence that either "the full force of Twitter" is being employed, nor that the hashtag is being used against "anyone who criticises the use of psychiatric medication", nor that the press is being silenced -- especially on the day when The Guardian tackles antidepressants with (1) a lead story, (2) a Comment, (3) a data blog, (4) video, (5) user responses. And note that the hashtag hasn't been deployed against the coverage. “

    You’re right that the Guardian coverage on Wednesday was not criticised for pill shaming, but I’d argue that there was nothing in the Wednesday coverage that took a critical stance to medication. On Thursday, however, when the Guardian wrote a follow-up piece that highlighted comments from GPs who worried about overprescribing antidepressants, the pill shaming hashtag was used. I don’t mean to sound pedantic, but want to highlight how articles that criticise medication could all be easily labelled as pill shaming and dismissed, and I believe this is indeed happening to an extent.

    I’d also like to respond your broader critique of the above article, in which you say that I avoid the debating question until the last paragraph. I have to respectfully disagree with you on this. My intention with the article was to articulate that the three original pieces have their flaws, but also have some merits which got quickly lost in the Twitter reaction. I also wanted to say that “pill shaming” may make it harder to talk about alternatives to medication for people who have less severe mental health problems (and so do not necessarily need to rely on medication). Both of these points are examples of conversations being limited or shut down. Perhaps the article doesn’t read that way to you (in which case I apologise), but as I read it I feel I’ve covered those points throughout the piece, and so don’t feel that I’ve ‘avoided the question’ until the last paragraph.

    Thank you for your responses on this comments thread. I really value your input: it has made for a lively discussion and has given me food for thought!

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  15. I'm concerned about the medicalisation of life; over-prescribing and how sometimes normal difficult emotions are (mis)diagnosed as an illness requiring meds. I expressed this view on twitter and said how I think Joanna Moncrieff does make some valid points. Immediately I was accused of pill shaming, lack of empathy and insulting people who suffer from real deep depression.

    I have never felt that people who seek help and take pills for depression (as I used to do) should be shamed for doing so. I have no wish to make anyone feel that taking their medication is wrong. To take or not to take meds are individual (and hopefully informed) decisions. Some people it helps and others not.

    I do not see why my criticisms of the use of psychiatric medication have been taken as criticisms of people who use it. I would have liked to engage in constructive debate about this important topic but found I couldn't get beyond trying to defend my views against the strongly felt accusations of pill shaming.

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