The Two Faces of Medications: A Qualitative Study on Recovery Processes of Clients with Severe DSM Diagnoses Who Were Able to Recover without Ongoing Reliance of Medications

Background: Advances in knowledge about biochemical and neurological aspects of mental illness have immensely contributed to treatment of mental health conditions but at the same time also led to enormous growth in the use of psychotropic medications since the 1970s. While medications have proven to be extremely helpful in many cases, they might also lead to problems because of well-documented negative side effects. There is literature that focuses on patients’ resilience in their recovery process. These studies have found that people with an optimistic attitude, are hopeful, have inner strength, have support from others, take an active role in their recovery, and take life day by day and in small steps are also more likely to recover. The purpose of this study is to explore the lived experience of clients pertaining to their use of medications in their recovery process as well as factors that contributed to their recovery when they were not relying on medications. 

Methods:  This was a qualitative inquiry that adopted an emergent design based on the constant comparison method suggested by a grounded theory approach.  Twenty participants were recruited based on theoretical sampling. Inclusion criteria were: (1) people who have been formally diagnosed with a DSM diagnosis of schizophrenia, bipolar, or major depression by a psychiatrist, (2) people who have not used psychotropic medications for at least the past year of their recovery process; (3) people who meet the operationalized definition of recovery as detailed in Liberman, & Kopelowicz (2002) and also have scores above the clinical cut-off of SCL-10 (Rosen et al., 2000).Three research team members were involved in the data analysis process. Line by line open coding of the data began after the first several transcripts followed by focused codes based on research team discussion. Redundant codes were consolidated based on developing theoretical perspectives. All codes were then reviewed by the full team until consensus was reached prior to the final coding process.

Results: Both positive and negative effects – the two faces of psychotropic medications - have been identified. Medications reduced and controlled symptoms.  Medications could also produce side effects, “numbed” the client’s ability to regulate emotion, and intervened with cognitive function as well as other “normal” functioning. These processes might contribute to exacerbating mental health problems. Moreover, the use of medications might “reduce” the motivations for clients to address the more complex underlying factors for symptoms, e.g. unresolved trauma and life difficulties.

In addition to medications, several factors and processes emerged as contributing to successful ongoing recovery. These included internal processes pertaining to cognitive/perspective change, emotional management, and meeting physical and spiritual needs. External processes included professional psychotherapy, social support, and having an external focus, including becoming involved in activism to change the current mental health treatment system.

Conclusion and Implication: Findings of this study expanded our understanding of clients’ lived experience of medications in their recovery process. Findings also have significant implications for the development of complementary behavioral treatment and strengths-based programs for clients that emphasizes empowerment, utilizes self-efficacy and personal resources.