One Size Does Not Fit All: Part 2 of a Discussion on the Role of Medication in a Windhorse Therapeutic Environment

Today’s podcast, the last in an 8-part series on psychotropic medications, is an open-hearted conversation between Windhorse community members Emily Ashley, Joe Calcagno, Chris Emerson, and Eugenie Morton.

Looking back, we initially didn’t anticipate spending this much time on meds. But once entering the discussion—and knowing how critical it is to accurately understand the issues at hand—we decided to deepen our presentation with Windhorse staff and clients who actually use or have used them. Today you’ll hear a conversation with people who have extensive personal experience in this territory.

As we conclude this series, I want to again bring attention to a theme that’s pervaded these conversations: People understandably have strong opinions about psychotropic medications, and this has produced intense polarities in how they are viewed and used—or not used. At Windhorse we practice in a middle path that takes into consideration all the various conditions and elements that determine whether a person wants to use meds or not, and how to live well with that choice. Our collective experience includes so many stories within these polarities, like the man I met in the WCS Admissions process, after having been admitted for his 50th psychiatric hospitalization. Somehow the magnitude of the number 50 woke him up, and he realized that his life was just not working the way he was approaching it. So, he decided to see what would happen if he stayed on medications for his bipolar condition. A few years of stable life later, he was happier than he’d been in the last 25 years and had become a highly effective peer counselor. Or there is the client I’ve admired for over 25 years for her big heart and fierce determination, who stated early in our relationship that she “would rather die than take medications.” There was no question that she really meant it. Life for her has not been easy, but she’s learned over time about what accommodations must be made around her vulnerabilities and the vicissitudes of her extreme mind states. Another woman I recall vividly, probably in her mid-30s, was a high school teacher. We met about five years ago at a conference where an author—very well-known for his research on how the use of anti-psychotic medication is strongly contraindicated—had just presented. She had clearly been

crying and pulled me aside to share how she always felt like such a failure when hearing these kinds of presentations. She hated the basic idea of meds, but every time she tried to go off of them, and she’d always done so with discipline, patience, and in collaboration with her psychiatrist, she ended up in the hospital. After losing a couple of jobs, she resigned herself to staying on the most minimal effective dosage possible. And so far, that actually felt okay. There’s also the client I’ve known since his teens, who in the last 20 years has learned how to accurately ground his life in simplicity, consistent discipline, work, and healthy relationships. He’s been medication-free for the last five years, with amazingly resilient stability of mind and moods.

And one last story produced a bit of a surprise for me in the form of a rare, un-ambivalent declaration. I was having dinner recently with a former client whom I worked with in the early 1990s. Since we first met, he’s always been on high doses of atypical anti-psychotic medications and has also been passionately engaged in life: with various kinds of work, meditation, and most recently reconnecting with his art as an abstract painter. Though one of the most disciplined people I know, occasionally his meds will get a little out of focus and he’ll enter a period of mania. Somehow, by awareness and what appears to be extremely good fortune, he’s managed to not just miraculously stay out of the hospital but to survive these extreme episodes. At dinner I shared with him that we were doing these podcasts on medications, and that I’d like to know how he feels about his experience with meds. He immediately laughed and boomed, “I love my meds! They let me to have the life I have, with a lot of joy and connection to people. And a huge thing for me is that they allow me to actually connect with the magic in my life, as opposed to being swamped by it.”

Today’s podcast, like all the others in this series, contains the voices of people who know the gravity of extreme mental states. From extensive experience, they also understand how critical it is to the process of recovery that one can discern dream states from reality. The subtle and exquisitely tricky sweet-spot of whether a psychotropic medication enhances that discernment or obscures it depends on so many very personal variables—indeed, one size truly does not fit all.

We hope this has been helpful and please share it with your friends,

Chuck Knapp